Diagnostics

Due to the characteristic clinical picture of an epidural hematoma, the diagnosis is often abbreviated. The doctor’s knowledge and interpretation can be supported or confirmed by imaging techniques. The clinical picture is characterized by the staggered symptomatology and the uneven pupil size.

In addition, the unilateral loss of various bodily functions and the progressive deterioration of the condition can be interpreted as an indication of bleeding. During the physical examination, a conspicuous reflex status is impressive in many cases. An existing paralysis strengthens the patient’s reflexes, while arbitrary movement is not possible.

Computer tomography (CT) can be used to diagnose or confirm 90% of epidural hematomas. The hematoma appears in the CT image as a brightened (high density; hyperdense), sharply defined area, which lies biconvex (lenticular) to the skull bone from the inside. Due to the one-sided pressure caused by the bleeding, the brain centerline is probably shifted to the healthy half of the head.

Magnetic resonance imaging (MRI) can also be used for diagnostic purposes. If a spinal epidural hematoma is suspected, MRI is increasingly chosen as the imaging method. In the laboratory, the search for the cause can be accelerated by checking the coagulation values and the platelet count if a traumatic origin of the haematoma can be ruled out.

Complications and late effects

An epidural hematoma can lead to an entrapment syndrome as a complication due to the ongoing pressure situation in the skull. A distinction is made between two different localizations. The upper incarceration is caused by the displacement of the temporal lobe, which slides under the tentorium cerebelli (cerebellar tent).

This framework, consisting of meninges, is attached to the cerebellum and separates it from the cerebrum (telencephalon). Due to its stabilizing and protective function, the cerebellum tent is relatively robustly built and has little movement. As a result, the temporal lobe is shifted to the middle when it is displaced and exerts pressure on the diencephalon (mesencephalon), which contains important control centers of the human body.

If the pressure becomes excessive, an epidural hematoma can lead to the death of the patient. The nerve tracts that mediate the movement of the body (pyramidal tracts) run close to the diencephalon and are also compressed.If there are sudden paralysis symptoms, this can be a sign of a beginning entrapment. In addition to the upper, a lower incarceration can also occur.

This equally life-threatening process is mediated by the cerebellum, which is pressed down. This can cause the cerebellum to be squeezed into the Foramen ovale (oval hole). The Foramen ovale is located on the underside of the skull and represents the entry point of the spinal cord into the head.

The hole also contains a part of the brain stem – especially the medulla oblongata. Among other things, this medulla is responsible for breathing control. If the cerebellum now presses on the brain stem, essential functions may be lost, for example respiratory arrest, which can lead to the patient’s death.

The late effects can vary if the brain is subjected to prolonged or severe pressure due to the epidural hematoma. In most cases, the paralysis symptoms that occur are reversible, but they can also be permanent if the pressure on the brain is not relieved quickly enough. Furthermore, neurological deficits can occur, which are related to the localization of the bleeding.

For example, the speech center may remain impaired even after a successful operation. About 20% of patients suffer a permanent disability from such an injury. In the case of a spinal epidural hematoma, possible late effects also depend on the speed of medical attention.

All symptoms that develop in the course of the operation can be completely reversible. However, if the spinal cord is affected by the haematoma for a longer period of time, permanent damage may occur. This usually leads to the development of cross-sectional syndromes in which the patient loses motor skills as well as the sensation of touch, temperature and pain from the height of the bleeding.