Frequency distribution
Since epidural hematoma is in most cases associated with a craniocerebral trauma, the frequency distribution is accordingly designed to indicate the presence of this traumatic injury. Most craniocerebral trauma is caused by car accidents and most car accidents are caused by people of lower age. As a result, the majority of patients suffering from epidural hemorrhage are younger than 40 years of age.
There is also an uneven gender distribution. Men are generally considered to be more risk-taking and aggressive in road traffic, which is also reflected in the proportion of serious car accidents caused by men. For every 5 men with epidural bleeding there is only one woman with the same injury.
Any cerebral hemorrhages of a traumatic nature are more common among alcoholics. Due to the permanently alcoholized state, they often fall and injure themselves on the head unprotected due to lack of reflexes. In addition, since there is usually a disease of the liver in which important substances for blood clotting should actually be produced, this circumstance generally aggravates bleeding and promotes its development.
Therapy
An epidural bleeding (both intracranial and spinal) is an absolute emergency. If possible, an immediate hospitalization must take place. The therapy of choice is neurosurgical surgery.
The cranial bone is first drilled out as quickly as possible (trepanation) in order to relieve the pressure from the brain tissue, which is built up by the increasing bleeding. If this is not done, the tissue is destroyed with permanent damage and the patient may even die. If it has been possible to relieve the pressure on the brain, the bruise is removed – the still liquid blood is sucked out and the already coagulated blood is scraped off.
This is also the procedure for spinal bleeding. The vessel causing the haemorrhage should be found and closed again to prevent further bleeding and the reopening of the surgical site. In chronic forms, repeated operations may be necessary.
Prognosis
Due to the severity of the secondary damage caused by an epidural hematoma, there is a relatively high mortality rate. Despite attempts to treat the bleeding surgically, the patient may die. About 30 to 40 % of the injuries end fatally.
In about 20% of patients, the bleeding has already caused such damage to the brain that a permanent disability exists, but the patient’s life can be saved. On average, half of the patients can be saved without permanent consequential damage. In contrast to the sometimes poor prognosis for deeper bleeding in the spinal cord, the prognosis for epidural bleeding is rather positive.With rapid treatment the symptoms usually disappear completely. Even an already developing cross-sectional symptomatology can completely disappear.