Epidural Hematoma: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • Assessment of consciousness using the Glasgow Coma Scale (GCS).
  • General physical examination – including blood pressure, pulse, body weight, height; furthermore:
    • Inspection (viewing).
      • Eyes [anisocoria (lateral difference in diameter of pupils)]
      • Skin and mucous membranes
      • Neck
      • Extremities
    • Auscultation (listening) of the heart
    • Auscultation of the lungs
    • Palpation (palpation) of the abdomen (abdomen), etc.
  • Neurological examination – assessment of the patient’s level of consciousness; functional deficits (severity)?
    • Epileptic seizures (convulsions)?
    • Contralateral hemiparesis (hemiplegia on the side of the body opposite the hemorrhage)?
    • Sensory and motor function check.
    • Testing reflexes (especially the biceps tendon reflex (BSR), triceps tendon reflex (TSR), radius periosteal reflex (RPR), patellar tendon reflex (PSR) and the Achilles tendon reflex (ASR, also triceps surae reflex), Babinski reflex (the pressureful brushing of the lateral edge of the sole of the foot leads to an upward extension of the big toe)

Square brackets [ ] indicate possible pathological (pathological) physical findings.

Glasgow Coma Scale (GCS) – scale for the estimation of a disorder of consciousness.

Criterion Score
Eye opening spontaneous 4
on request 3
on pain stimulus 2
no reaction 1
Verbal communication conversational, oriented 5
conversational, disoriented (confused) 4
incoherent words 3
unintelligible sounds 2
no verbal reaction 1
Motor response Follows prompts 6
Targeted pain defense 5
untargeted pain defense 4
on pain stimulus flexion synergisms 3
on pain stimulus stretching synergisms 2
No response to pain stimulus 1

Assessment

  • Points are awarded for each category separately and then added together. The maximum score is 15, the minimum 3 points.
  • If the score is 8 or less, a very severe brain dysfunction is assumed and the there is a risk of life-threatening respiratory disorders.
  • With a GCS ≤ 8, securing the airway by endotracheal intubation (insertion of a tube (hollow probe) through the mouth or nose between the vocal folds of the larynx into the trachea) must be considered.