bubble_chart Overview

Epidural hematoma refers to a hematoma where blood accumulates between the skull and the dura mater. It is caused by direct external force to the head, resulting in skull fracture or localized skull deformation leading to traumatic hemorrhage of blood vessels. The typical clinical presentation includes brief unconsciousness after head injury, followed by increased intracranial pressure symptoms, recurrence of unconsciousness, and signs of brain herniation. Its incidence accounts for 2-3% of closed head injuries and 25-30% of intracranial hematomas, with most cases being acute and solitary. Epidural hematoma is one of the most severe secondary complications of head injury, and treatment outcomes are closely related to timely diagnosis and intervention. With early diagnosis and prompt surgery, the prognosis is generally favorable; otherwise, irreversible brain damage may occur. The mortality rate is approximately 10%.

bubble_chart Clinical Manifestations

1. Most cases of transient unconsciousness after head injury are accompanied by localized scalp injuries.
2. Severe headache, nausea, vomiting, and restlessness may occur, along with unilateral limb weakness, aphasia, etc.
3. Repeated unconsciousness that deepens; in cases of supratentorial hematoma, the pupil on the side of the hematoma first dilates, light reflex disappears, contralateral limb paralysis occurs, muscle tone increases, tendon reflexes become hyperactive, and respiration and pulse slow while blood pressure rises. In advanced stages, both pupils dilate, decerebrate rigidity appears, and pathological breathing patterns emerge.

bubble_chart Diagnosis

1. There is a history of head injury, often with scalp injury and skull fracture.
2. After the injury, there may be a brief period of unconsciousness, followed by lucidity (i.e., the lucid interval), but in rare cases, there may be no unconsciousness. Later, due to the enlargement of the hematoma, brain compression leads to unconsciousness.
3. During the lucid interval, there is often severe headache, nausea, vomiting, and restlessness; there may also be hemiplegia, aphasia, slowed respiration and pulse, elevated blood pressure, followed by unconsciousness and deepening. In the advanced stage of supratentorial hematoma, the temporal lobe herniation syndrome appears.
4. Skull X-rays often show fracture lines crossing the grooves of meningeal vessels or venous sinuses. In cases of supratentorial hematoma, ultrasound examination reveals midline shift to the contralateral side. Cerebral angiography, head CT, or MRI can reveal the location and size of the hematoma.
5. Exploratory skull drilling reveals an epidural hematoma.

bubble_chart Treatment Measures

1. For patients with small hematomas and mild symptoms, drug treatment can be considered, but close observation of the condition is necessary.
2. Patients with large hematomas and severe symptoms should undergo immediate surgical treatment.
3. Symptomatic supportive treatment should be provided.

About 95% of patients with epidural hematomas have skull fractures, and the hematoma is mostly located at the impact site or adjacent areas. Therefore, skull X-rays should be performed after head injuries. For conscious patients with skull fractures, if symptoms of increased intracranial pressure such as severe headache, vomiting, and restlessness occur, epidural hematoma should be suspected, and the patient should be immediately transferred to a hospital capable of performing craniotomy. CT scans are the preferred diagnostic method. Timely surgery generally leads to a good prognosis. If CT or MRI equipment is unavailable, cerebral angiography should be performed for diagnosis. In critical cases where CT scans cannot be performed promptly, the location of the head injury, fracture lines, and signs can be used for localization. Timely exploratory skull drilling and hematoma evacuation can often save the lives of some patients. For patients with normal initial CT scans after injury, a repeat CT scan should be performed if symptoms of increased intracranial pressure develop to avoid misdiagnosis.

bubble_chart Cure Criteria

1. Cure: Hematoma disappears, symptoms and signs disappear, normal life and work are restored, with possible residual skull defect;
2. Improvement: Hematoma disappears, symptoms improve, with residual neurological dysfunction, able to take care of oneself or partially, with some work ability or partial loss of labor capacity.
3. Not cured: Hematoma does not completely disappear, symptoms and signs show no improvement, unable to take care of oneself.