An epidural hematoma is formed due to a traumatic brain injury (TBI) and is an accumulation of blood that fills the internal space between the dura mater and the bones of the skull.

The formation of an epidural hematoma occurs as a result of a traumatic brain injury. Epidural hematomas are characterized by a traumatic nature of origin.. The most common causes of its formation are the following mechanisms of action:.

a blow to the head with a small object: a stone, a hammer, etc..

hitting the head on an immovable object: falling from a small height, hitting a step, the corner of a table, etc..

The zone of contact in these cases is usually the lower parietal or temporal region of the skull, and the source of bleeding is the diploic and meningeal veins, venous sinuses, the middle meningeal artery and its branches..

Symptoms In most cases, there are characteristic clinical manifestations of epidural hemorrhage.. It is characterized by a pronounced light gap - the victim loses consciousness for a short time, which is then restored, but some stupor remains..

The pathology is manifested by a moderate headache. The main complaints are: moderate headache, weakness and dizziness.. Initially, this condition is regarded as mild to moderate TBI..

The patient has spontaneous nystagmus, slight asymmetry of the nasolabial folds, congrade and retrograde amnesia, mild meningeal signs, and mild anisoreflexia..

When the light period passes, the patient's health deteriorates sharply, the following symptoms appear:.

nausea and vomiting;

acute progressive headache;

psychomotor agitation;

rapidly progressive disorder of consciousness - from stupor to deep depression of consciousness and coma.

In some cases, the rapid fading of consciousness immediately turns into a coma, which can cause concomitant arterial hypertension, bradycardia, increasing brachiocephalic paresis of the contralateral hematoma of the extremities and side of the face.

The pupil of the eye on the side corresponding to the site of the injury expands, followed by a lack of reaction to light. Sometimes, focal symptoms (anisocoria and paresis) are noted first, which precedes the onset of symptoms of cerebral compression..

A course with an erased light period It is possible for a pathology with an erased light period. This symptom indicates profound impairment of consciousness and severe TBI.. After a few hours, the coma changes to an intermediate state - stupor, at which time the opportunity for verbal contact with the victim is provided.. The doctor determines by his behavior whether there is hemiparesis and how intense the headache is..

The severity of symptoms depends on the severity of the injury. A light interval of this type can last from a couple of minutes to several days, and after it there is a sharp deterioration in the patient's well-being - increasing excitement flows into a coma, and paresis worsens to complete plegia of the limbs opposite the side on which the hematoma formed.

As a result, it is possible to develop violations of vital functions and damage to the brain stem, which can be manifested by severe oculomotor and vestibular disorders, hormetonia, etc..

Hematoma without a light periodEpidural hematoma without a light period indicates multiple brain damage and severe TBI. Almost immediately after the impact, the victim falls into a coma and remains in this state unchanged..

The longest duration of the light interval occurs in subacute epidural hematomas and can reach from 10 to 12 days.. The consciousness of the patient during this period remains mostly clear, but some light focal signs and a tendency to bradycardia are fixed..

In the future, gradually, sometimes in waves, the disturbances of consciousness worsen up to deep stupor against the background of excitement and severe headache..

Depending on the place where the formation is located, focal symptoms vary, namely:.

Location of injury.

Manifestations.

frontal lobe.

Mental disorders with frontal coloration against the background of weak severity of other focal symptoms.

Parasagittal region.

Pyramidal disorders predominate with the greatest severity of paresis in the foot.

Occipital region.

Homonymous hemianopsia (loss of visual fields of the same name).

DiagnosisDiagnosis of epidural hematoma is carried out by a neurosurgeon or neurologist together with a traumatologist. The anamnesis, complaints of the victim and typical clinical manifestations are taken into account - bradycardia, impaired consciousness, etc..

It is mandatory to carry out an x-ray of the skull, during which the presence of a fracture crossing the furrows of the meningeal vessels is established. In most victims, the localization of the resulting cavity corresponds to the site of the fracture..

To clarify the diagnosis, CT or MRI is prescribed. Other diagnostic methods:.

Study.

Description.

Computed tomography (CT).

CT allows you to more accurately determine the volume of the formed hematoma and its location, and also provides more complete information about other intracranial injuries, if any..

Magnetic resonance imaging (MRI).

MRI visualizes isodense and small masses. It is used to assess the state of the brain stem and basal structures, as well as for the differential diagnosis of epidural and subdural hematomas..

Echoencephalography (Echo-EG).

If MRI or CT is not possible, echo-EG of the brain is preferred.. The study helps to determine the presence of a pathological volumetric process in the substance of the brain. Echoencephalography usually shows progressive displacement of the middle ear.

TherapyConservative treatment If the volume of the resulting cavity does not exceed 30-50 ml, the patient does not have progressive symptoms and signs of brain compression, conservative treatment is possible.

The main goal of therapy is the gradual resorption of an array of outflowing blood, and therefore it is vital to constantly monitor the dynamics of the volume of the hematoma..

Surgical intervention For larger masses and brain compression, urgent surgical intervention is indicated.. In such cases, a milling hole is made in the area of \u200b\u200b\u200b\u200bthe skull with the alleged localization of the accumulation..

The choice of treatment tactics is determined by the degree of damage and its localization. Through it, a part of the hematoma is removed using a special aspirator of blood clots and fluid, after which a craniotomy is performed with the removal of the formation in full and the ligation of the damaged vessel.

If the source of bleeding is veins, they are coagulated, followed by tamponing with a hemostatic sponge.. In cases of damage to diploic veins, surgical wax is used, and if injuries of the sinuses are found, they are plastic and tamponade. At the end of the operation, a bone flap is put in place and the wound on the surface of the scalp is sutured..

Simultaneously with the ongoing manipulations, hemostatic, decongestant and symptomatic treatment is used.. During the recovery period, patients receive neurometabolic and absorbable drugs.. To speed up the recovery process of the muscles of the paretic limbs, therapeutic massage and physical education are indicated..

Closed external drainage As an alternative to craniotomy, a minimally invasive surgical procedure can be chosen - closed external drainage. This method is recognized as more gentle and has a number of advantages, however, it can only be used in cases where emergency removal of the formation is not required..

According to the indications, a minimally invasive surgical intervention is performed. An intraosseous needle is inserted through the skin, which is used to perforate the skull. A special drainage catheter is placed in the resulting hole, the diameter of which does not exceed 3 mm.. A fluid receiver is attached to it, which is placed 15–20 cm below head level to ensure optimal outflow of fluid..

When conducting minimally invasive therapy, the integrity of the cranium is not violated, and the risk of infection and the likelihood of recurrence of the pathology are minimal..

Prognosis and possible consequences The prognosis for epidural hematomas directly depends on the age of the patient, the volume of formation and the timing of the operation.. The most favorable outcome is observed in the following cases:.

conservative treatment of small lesions;

surgical intervention at the stage of moderate decompensation. At the same time, the probability of restoring lost neurological functions is the highest, and the risk of mortality is minimal..

When performing an operation at the stage of decompensation, the prognosis is the least positive. In 40% of cases, craniotomy ends in death, and surviving patients often have significant neurological deficits..

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