What is an Epidural Hematoma(EDH)?
Epidural hematoma or extradural bleeding is a condition where blood collects in the epidural area, which is the area between the skull and the dura mater layer.
The dura mater is the outermost membrane or layer of the meninges (membranes of the brain and spine) that surrounds and protects the brain and spine. In the head, the dura mater is usually attached to the inner skull and is therefore susceptible to bleeding.
Epidural hematoma can occur in the head and spine, but usually occurs in the head due to an injury that causes a fracture of the skull.
This condition, especially when it occurs in the arteries in the brain, is serious and requires emergency treatment to remove the accumulated blood before it causes further injury.
Symptoms of Epidural Hematoma
Both head and spinal epidural hematomas have symptoms that can be felt immediately or several days after the injury. Some symptoms of epidural hematoma are:
- Losing consciousness when the injury occurs, then regaining consciousness for several hours before slowly deteriorating and losing consciousness again as a sign of blood pooling in the epidural area. Not everyone experiences this condition.
- Feeling sleepy or having a severe headache after the injury. People with epidural hematoma who lose consciousness may also experience this after they regain consciousness.
- Nausea or vomiting.
- Confusion or confusion.
- Weakness in the arms or legs on one side of the body.
- Having difficulty speaking.
- Talking fluently, but then the next minute feeling sick and losing consciousness.
- Seizures
- Dilated pupil in one eye, especially on the side opposite the weak side of the body.
- Bruises around the eyes.
- Discharge of clear fluid from the nose or ears.
- Bruise behind the ear.
- Shortness of breath or having a changing breathing pattern.
Causes of Epidural Hematoma
This condition is caused by several factors, depending on the area experiencing this condition.
In addition, an epidural in the spine is called a spinal epidural hematoma and is less common than an epidural hematoma that occurs in the head.
Epidural hematoma in the head is called intracranial extradural hematoma because it is another type of bleeding that also occurs in the head (intracranial hematoma).
Causes of epidural hematoma according to location, namely:
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Epidural Hematoma Head
It is usually caused by a head injury that causes a fracture to the skull, such as a road traffic accident. Other causes include a fall or a very hard or intense blow, physical contact during sports.
The blood that appears as a result of this impact then collects and forms a hematoma which then creates pressure on the brain tissue.
As a result, the brain will begin to lack blood supply and symptoms begin to appear. If left untreated, excessive pressure on the brain can trigger brain damage. Most cases of epidural hematoma are dangerous situations because they can occur immediately after an accident.
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Epidural Spinal Hematoma
It usually occurs due to injury around the spine, namely injury caused by a procedure to take fluid from the spine when trying to diagnose a disease or an epidural anesthesia procedure for childbirth.
Injuries can also occur as a result of taking anticoagulant (blood thinner) drugs as part of the treatment.
Epidural hematoma is prone to be experienced by people aged 11 – 16 years, men, and people who have a habit of consuming excessive alcohol.
The risk will be reduced for those over 60 years of age because they have a layer of dura that is firmly attached to the skull so that the dura does not easily come loose and bleed.
Epidural Hematoma Risk Factors
Here are a number of factors that can cause epidural hematoma:
- Head injuries due to traffic accidents, falls, or impacts during sports.
- Children are more susceptible because their skulls are more susceptible to ruptured blood vessels after an injury.
- Bleeding disorders or use of blood-thinning medications may increase the risk of bleeding after a head injury.
- Use of alcohol and certain drugs can increase the risk of head injury and also affect blood clotting ability.
Diagnosis of Epidural Hematoma
The following steps can be taken to diagnose epidural hematoma:
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Medical History and Physical Examination
The doctor will ask about the history of head injuries and symptoms experienced by the patient. A neurological examination to assess brain function is also necessary for the doctor to do.
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Imaging
- CT Scan (Computed Tomography): This is the most commonly used imaging test to diagnose epidural hematoma. A CT scan can quickly show bleeding and pressure on the brain.
- MRI (Magnetic Resonance Imaging): Sometimes used to provide more detailed images of bleeding and brain tissue.
Epidural Hematoma Treatment
The first action is to stabilize the patient’s condition, after which medication is administered, and surgical procedures are performed.
An enlarged or worsening epidural hematoma must be removed, usually through a craniotomy procedure, which is making a burr hole in the skull bone. The patient’s condition is then continuously monitored in the intensive care unit after surgery.
Prompt treatment of an epidural hematoma can reduce permanent brain damage, although there is still a possibility that it will occur, such as difficulty speaking, seizures, or weakness on one side of the body.
However, this condition can improve with a series of physical therapies or medications.
Epidural Hematoma Complications
If not treated quickly, epidural hematoma can cause the following conditions.
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Increased Intracranial Pressure
Continued bleeding can cause increased pressure inside the skull, which can damage brain tissue.
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Brain Herniation
The increased pressure can cause part of the brain to be pushed out of its normal position, a condition called brain herniation. This condition can be fatal.
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Permanent Brain Damage
If not treated promptly, the pressure and damage from the hematoma can cause permanent brain damage, affecting cognitive, motor, and sensory function.
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Seizures
Damage to the brain from bleeding can cause seizures, either immediately after the injury or as a long-term complication.
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Infection
If surgery is required to drain the hematoma, there is a risk of infection in the brain tissue or around the surgical area.
Epidural Hematoma Prevention
Because the main cause is collision. Well, here are some preventions that you can do:
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Using Protective Equipment
- Always wear a helmet when riding a motorcycle, bicycle, or engaging in high-risk sports such as skateboarding, snowboarding, or playing hockey.
- Be sure to use appropriate head protection that meets safety standards when working in high-risk environments or when performing activities that have the potential to cause head injuries.
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Use of Seat Belts
Always wear a seat belt when driving a car, and make sure children use a child safety seat appropriate for their age and weight.
Seat belts can reduce the risk of serious head injury during an accident.
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Prevent the Risk of Falls at Home
- Install stair guards, bathroom grab bars, and non-slip flooring to reduce the risk of falls, especially for the elderly.
- Make sure the house has good lighting, especially in the stairs and hallways.
- Arrange furniture properly to avoid obstacles that could cause trips and falls.
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Occupational Safety Training
Take the work safety training provided by the company to learn how to avoid the risk of head injury.
- Use appropriate PPE when working in high-risk areas such as construction sites or factories.
- Make sure the equipment used in the work is always in good condition and safe to use.
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Prevention in Sports
- Follow all safety rules imposed in the sport, including the use of recommended protective equipment.
- Learn and use proper techniques in sports to reduce the risk of head injury.
- Ensure there is adequate supervision during training and matches to promptly respond to any head injuries.
