Introduction An epidural hematoma is a mass of blood in the space between the inner table of the skull and the

dura mater. Typically caused by traumatic brain injury, the bleeding into the epidural space can cause pressure on the brain which can lead to neurological symptoms including coma and death if severe enough. The epidural space is the area between the inner part of the skull and the dura, "on top of" the dura. Normally, there is no space between these structures. However, with some head injuries, the blood vessels of the dura in this area can become torn and bleed. The bleeding fills this space, separating the bone from the dura. As the hematoma enlarges, it can push on the brain beneath, causing compression and shifting of the brain which can cause neurological symptoms. While an epidural hematoma can certainly occur with more severe head injury, they can also occur with relatively mild injuries, particularly if they are in the temporal area and cause a fracture of the bone of the skull. The fracture can tear blood vessels in this area, leading to the hematoma. The most common cause of intracranial epidural hematoma is traumatic, although spontaneous hemorrhage is known to occur. Hemorrhages commonly result from acceleration-deceleration trauma and transverse forces. 10% of epidural bleeds may be venous, due to shearing injury from rotational forces. Epidural hematoma commonly results from a blow to the side of the head. Thepterion region which overlies the middle meningeal artery is relatively weak and prone to injury. Thus only 20 to 30% of epidural hematomas occur outside the region of the temporal bone.[10] The brain may be injured by prominences on the inside of the skull as it scrapes past them. Epidural hematoma is usually found on the same side of the brain that was impacted by the blow, but on very rare occasions it can be due to a contrecoup injury.

Patients with this type of condition frequently have bruises around their eyes and a bruise behind their ear. They may also have clear fluid draining from their nose or ears due to a tear in part of the covering of the brain. These patients usually require close observation in the hospital. The person may have varying degrees of symptoms associated with the severity of the head injury. The following are the most common symptoms of a head injury. However, each individual may experience symptoms differently. With this type of moderate to severe head injury, immediate medical attention is required. Symptoms may include: y y y y y y confusion loss of consciousness blurred vision severe headache vomiting loss of short-term memory, such as difficulty remembering the events that lead right up to and through the traumatic event slurred speech difficult walking dizziness y y y y y y y y y weakness in one side or area of the body sweating pale skin color seizures behavior changes including irritability blood or clear fluid draining from the ears or nose one pupil (dark area in the center of the eye) looks larger than the other eye deep cut or laceration in the scalp open wound in the head

y y y

Epidural hematoma should be suspected in any individual who sustains head trauma. Although classically associated with a lucid interval between the initial loss of consciousness at the time of impact and a delayed decline in mental status (10-33% of cases), alterations in the level of consciousness may have a variable presentation. Posterior fossa epidural hematoma may exhibit a rapid and delayed progression from minimal symptoms to even death within minutes.