Epidural hemorrhage is a buildup of blood between the skull and the membrane surrounding the brain, commonly caused by head injuries. If left untreated, it can cause life-threatening swelling and impair consciousness and motor skills. Treatment involves surgical decompression to drain the accumulated blood. Epidural bleeding can also occur in the spine, causing pain and paralysis, and is treated with surgical decompression through drainage.
An epidural hemorrhage (EDH) is an accumulation of blood between the skull and the dura mater, the membrane that surrounds the brain. Also called a hematoma, it is a common consequence of head injuries. If left untreated, blood can fill the intracranial space and cause life-threatening swelling. The treatment relieves pressure on the brain, using neurosurgical decompression to drain fluid from under the skull. There is another type of epidural hemorrhage that occurs in the spine, when injured veins bleed into the surrounding space and increase fluid pressure between the bone and spinal cord.
Epidural bleeding is usually caused by a traumatic brain injury, commonly a concussion on the side of the head. This leads to arterial bleeding into the epidural space. Bleeding into the tissue around the brain will cause a hematoma if blood continues to pool outside the arteries. If enough blood volume builds up, the expansion can put pressure on the brain, severely impairing consciousness, motor skills, and the basic neural responses that regulate breathing and pupillary response. It can prove fatal within hours.
Depending on the extent of the head injury and the amount of bleeding, some patients with epidural hemorrhage remain fully alert, while others briefly lose consciousness or immediately go into a coma. Many patients, after recovering from the initial shock, experience what is called a lucid interval in which they are alert and function normally for one to a few hours. During this time, the area of the EDH will continue to grow until the pressure on the brain increases to the point that the patient loses consciousness. At this point, surgery is required to prevent rapid deterioration.
Treatment of epidural bleeding requires immediate surgical decompression to relieve the pressure. Surgery involves opening the skull and draining the accumulated blood. For small to medium-sized hematomas, a small hole is made, but for major hemorrhages, surgeons do a craniotomy to evacuate fluid and check for clots. Epidural bleeds can trigger seizures, so anticonvulsant drugs may be prescribed along with medications to reduce the risk of neurological infection.
Epidural bleeding can also occur in the spine. There, bleeding into the epidural space is more likely to come from damaged veins than from arteries. Pressure on the spinal cord at any level is painful and can cause bladder and bowel problems and paralysis below the bleeding point. An MRI is used to establish a diagnosis of epidural bleeding because there are many possible causes of spinal pain. Spinal epidural hematoma is usually treated with surgical decompression through drainage in a procedure similar to a lumbar puncture.
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