Epidural hematoma (EDH) (synonyms: Arterial epidural hematoma; epidural hemorrhage; epidural hemorrhage; epidural hematoma; epidural hemorrhage; nontraumatic epidural hemorrhage; nontraumatic epidural hemorrhage; chronic epidural hematoma; traumatic epidural hemorrhage; traumatic epidural hematoma; traumatic epidural hemorrhage; extradural hematoma; traumatic extradural hemorrhage; traumatic extradural hemorrhage; ICD-10-GM S06. 4: Epidural hemorrhage; ICD-10-GM I62.1: Non-traumatic extradural hemorrhage) is acute bleeding into the epidural space (space between the bones of the skull and the dura mater (hard meninges, outer boundary of the brain to the skull)).
In most cases, an epidural hematoma occurs in the course of an accident (trauma). This is called an acute traumatic epidural hematoma. Often, a skull fracture (fracture of the skull bone) is also present.
An epidural hematoma can also occur chronically. The symptoms then develop very slowly (over weeks to months). The affected person suffers from permanent headaches as well as dizziness attacks and often appears confused.
Epidural hematoma belongs to the intracranial hemorrhages (brain hemorrhages inside the skull) and, like subdural hematoma and subarachnoid hemorrhage (SAB), is an extracerebral hemorrhage (outside the skull; in the area of the meninges/ meninges) and thus to be distinguished from intracerebral hemorrhage (ICB; brain hemorrhage).
The following is the frequency distribution of epidural hematomas according to their location:
- 75% of cases: temporal area (temporal lobe).
- 10% of cases: parietal and frontal area (parietal lobe and frontal lobe/frontal lobe).
- 5% of cases: occipital area (occipital lobe).
- 4% of cases: bilateral and in the posterior fossa.
Epidural hematomas can occur not only intracranially, but also spinally (in the spine). In these cases, the patient’s consciousness is not affected. Pain occurs in the area of the hemorrhage. In the further course, there are corresponding neurological deficits below the injured area (e.g., paraplegia syndrome: initially flaccid paralysis of the musculature; concomitantly, sensitivity below the lesion is abolished).
Sex ratio: males to females is 5: 1.
Frequency peak: the majority of epidural hematomas occur in the context of traumatic brain injury (TBI), which is usually caused by car accidents. This explains why two-thirds of those affected are younger than 40 years of age or between 20 and 30 years of age.In young children, epidural hematomas are very common after skull injuries in the first two years of life.
Epidural hematoma is found in 1-3% of all traumatic brain injuries. In the setting of an epidural hematoma, other forms of hematoma must also be considered. In up to 20% of cases, intracerebral, subdural or subarachnoid hemorrhage is still present.
Course and prognosis: Epidural hemorrhage deteriorates rapidly. The growing mass may result in an entrapment syndrome and brainstem compression, which may ultimately lead to death. Only immediate surgery (craniotomy/opening of the skull and occlusion of the bleeding arterial vessel) can save the patient’s life. The prognosis depends on possible additional intracranial injuries or other concomitant injuries. If an isolated epidural hematoma is present and prompt action is taken, the prognosis is good.
The lethality (mortality related to the total number of people affected by the disease) is 30 to 40%. Approximately 50% of those affected survive without sequelae.
