The following are the major diseases or complications that may be contributed to by epidural hematoma (EDH): Cardiovascular system (I00-I99) Entrapment syndrome Upper entrapment: affects the temporal lobe Crushing of the diencephalon (controls vital processes!) → can lead to death Impairment of nerve pathways that control body movement; paresis (paralysis) may occur Lower entrapment: pressure … Epidural Hematoma: Complications
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 … Epidural Hematoma: Examination
Laboratory parameters of 1st order – obligatory laboratory tests. Differential blood count [anemia due to intracranial hemorrhage]. Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate). Coagulation parameters – activated partial thrombin plastin time (aPTT), anti-factor Xa activity (aXa), ecarin clotting time (ECT), INR (International Normalized Ratio), Quick value, thrombin time (TC). Laboratory … Epidural Hematoma: Test and Diagnosis
Therapeutic targets Emergency neurosurgical intervention is required to save the patient’s life: Reduction of intracranial pressure and hematomevacuation (evacuation of the hematoma/bruise) (see “Surgical Therapy“). Until then: Secure and stabilize vital functions Avoid secondary diseases and complications, e.g., posttraumatic cerebral edema If necessary, normalization of blood clotting Therapy recommendations Preoperative intracranial pressure reduction: Upper body … Epidural Hematoma: Drug Therapy
Obligatory medical device diagnostics. Computed tomography of the skull (cranial CT or cCT). If necessary, magnetic resonance imaging of the skull (cranial MRI or cMRI) – is more accurate, but too time consuming.
Therapy of choice is immediate cranial trephination (opening of the skull) to relieve pressure and hematoma evacuation (clearing out the hematoma). In addition, the bleeding must be localized and the injured vessel closed. Surgery should also be performed for smaller, nonspatial epidural hematomas, as the source of bleeding can be located and closed in this … Epidural Hematoma: Surgical Therapy
To prevent epidural hematoma (EDH), attention must be paid to reducing individual risk factors. Chronic subdural hematoma Behavioral causes Recreational drug use Alcohol abuse (alcohol dependence)
The following symptoms and complaints may indicate epidural hematoma (EDH): Pathognomonic (indicative of disease). Intermittent symptomatology: loss of consciousness → regaining consciousness (“symptom-free interval”) → renewed loss of consciousness (due to rising intracranial pressure). Main symptoms Vigilance disorder (decreased attention). Homolateral mydriasis (synonym: anisocoria/unilateral pupil dilation on the bleeding side). Contralateral hemiparesis (hemiplegia on the … Epidural Hematoma: Symptoms, Complaints, Signs
Pathogenesis (disease development) The brain is enveloped by three densely packed meninges (meninges; layers of connective tissue). They protect and stabilize the brain. The dura mater is the outermost and thickest layer. It is directly adjacent to the skull. The middle meninges are called arachnoid mater (cobweb skin). The pia mater (delicate meninges) is the … Epidural Hematoma: Causes
General measures Nicotine restriction (refraining from tobacco use). Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day). Review of permanent medication due topossible effect on the existing disease. Anticoagulants Coumarins (phenprocoumon* (product names: Marcumar, Falithrom); warfarin (product names: Coumadin, Marevan); acenocoumarol (product name: Sintrom). Direct inhibitors of … Epidural Hematoma: Therapy
The medical history represents an important component in the diagnosis of epidural hematoma (EDH). If acute epidural hematoma is suspected, the patient is admitted to the hospital as a medical emergency. If the patient is unresponsive, the medical history must be taken with relatives or contacts (= external medical history). Family history Are there frequent … Epidural Hematoma: Medical History
Cardiovascular (I00-I99). Intracerebral hemorrhage (ICB; cerebral hemorrhage). Subdural hematoma (synonyms: subdural hematoma; subdural hemorrhage; SDH) – bleeding into the subdural space of the skull (between the dura mater (hard meninges) and arachnoid mater (soft meninges or middle meninges)). Acute subdural hematoma (aSDH) – following severe traumatic brain injury (TBI) with brain contusions (brain contusions)Symptoms: Disturbances … Epidural Hematoma: Or something else? Differential Diagnosis