Epidural hematoma is a life-threatening condition caused by bleeding between the skull and the dura mater, most often from a head injury. It requires rapid diagnosis and evacuation to prevent neurological deterioration. Common symptoms include an initial loss of consciousness followed by apparent recovery and then progressive neurological decline. Diagnosis is typically made through CT scan showing a biconvex lens-shaped blood collection. Surgical evacuation is usually indicated for hematomas over 30ml or in patients with Glasgow Coma Scale less than 9 and pupillary abnormalities, while smaller hematomas may be monitored non-operatively.

1. Epidural Hematoma
dr. Vandy Ikra
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2. • an extra-axial collection of blood within the
potential space between the outer layer of the dura
mater and the inner table of the skull
• It is a life-threatening condition, which may require
immediate intervention and can be associated with
significant morbidity and mortality if left untreated
• Rapid diagnosis and evacuation are important for a
good outcome
Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah
Khairat, A. and Waseem, M., 2021. Epidural hematoma. In StatPearls
[Internet]. StatPearls Publishing.

3. Etiology
Traumatic
• Trauma Brain Injury
• Mechanisme
• Motor vehicle collisions
• Physical assaults
• Acidental falls
Non traumatic
• Mechanism
• Infection/Abscess
• Coagulopathy
• Hemorrhagic Tumors
• Vascular Malformations
Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah
Khairat, A. and Waseem, M., 2021. Epidural hematoma. In StatPearls
[Internet]. StatPearls Publishing.

4. • occurs in 2% of all head injuries and up to 15% of
all fatal head traumas
• Males are more often affected than are females
• the incidence is higher among adolescents and
young adults
• The mean age of affected patients is 20 to 30 years
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Epidemiology
Khairat, A. and Waseem, M., 2021. Epidural hematoma. In StatPearls
[Internet]. StatPearls Publishing.

5. • Arterial Injury
85% of all bleeding
Branch of the middle meningeal artery
Anterior meningeal artery or dural
arteriovenosus fistula at the vertex maybe
involved
Departemen Bedah RSMH/FK Unsri
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Pathophysiology
refference : Greenberg, M.S., 2016. Handbook of neurosurgery. 8th edn New
York.

6. • Venous Injury
Up to 10% are due to venous bleeding following
the laceration of dural venous sinus
In adults, 75% EDHs occur in the temporal region
In children, they occur with similar frequency in
the temporal, occipital, frontal, and posterior
fossa regions.
Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah
Khairat, A. and Waseem, M., 2021. Epidural hematoma. In StatPearls
[Internet]. StatPearls Publishing.

7. • An initial loss of consciousness
• a complete transient recovery (“often termed as a
lucid interval”)
• rapid progression of neurological deterioration
• Cushing Reflex
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History and Physical
Khairat, A. and Waseem, M., 2021. Epidural hematoma. In StatPearls
[Internet]. StatPearls Publishing.

8. • Subdural hematoma
• A posttraumatic disorder described by Denny-
Brown consisting of a “lucid interval” followed by
bradycardia, brief periods of restlessness and
vomiting, without intracranial hypertension or
mass
Departemen Bedah RSMH/FK Unsri
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Differential Diagnosis
refference : Greenberg, M.S., 2016. Handbook of neurosurgery. 8th edn New
York.

9. • CT Scan
• biconvex or lens-shaped mass on brain CT scan
• estimating the amount of blood present in an EDH :
ABC/2
• A: The maximum hemorrhage diameter on the CT slice with the
largest area of hemorrhage
• B: The maximum diameter 90 degrees to A on the same CT
slice
• C: The number of CT slices with hemorrhage multiplied by the
slice thickness in centimeters
• Swirl sign
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Evaluation
Khairat, A. and Waseem, M., 2021. Epidural hematoma. In StatPearls
[Internet]. StatPearls Publishing.

10. • MRI
• Assessing for EDH in the vertex and spinal EDH
• Angiogrhapy
• Assessing for EDH in the vertex
• Laboratory test : INR, PTT, PT, LFT
Departemen Bedah RSMH/FK Unsri
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Evaluation
Khairat, A. and Waseem, M., 2021. Epidural hematoma. In StatPearls
[Internet]. StatPearls Publishing.

11. • Neurosurgical Consultation & stabilize the patient -> ABCs
• Operative Management
• Craniotomy and Hematoma Evacuation
• Non Operative Management
• close observation with repeated neurological examinations and
continuous surveillance with brain imaging
• follow-up head CT scan within 6 to 8 hours following brain injury.
Departemen Bedah RSMH/FK Unsri
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Treatment/Management
Khairat, A. and Waseem, M., 2021. Epidural hematoma. In StatPearls
[Internet]. StatPearls Publishing.

12. Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah
• Indications for surgery
Level III*
1. EDH volume > 30 cm3 should be evacuated regardless of GCS
2. EDH with the all of the following characteristics can be managed
nonsurgically with serial CT scans and close neurological
observation in a neurological center
a) Volume < 30 cm3
b) and thickness < 15 mm
c) and with midline shift (MLS) < 5 mm
d) and GCS > 8
e) and no focal neurologic deficit
*Level III : its is strongly recommended that patients with an acute EDH
and GCS <9 and anisocoria undergo surgical evacuation ASAP
refference : Greenberg, M.S., 2016. Handbook of neurosurgery. 8th edn New
York.

13. Treatment/Management
• Indications Operative
Management
• Acute EDH
• Hematoma volume
greater than 30 ml
regardless of Glasgow
coma scale score (GCS)
• GCS less than 9 with
pupillary abnormalities
like anisocoria
• Indication NonOperative
Management
• EDH volume of less than 30 ml
• Clot diameter of less than 15
mm
• Midline shift of less than 5 mm
• GCS greater than 8 and on
physical examination, shows no
focal neurological symptoms.
Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah
Khairat, A. and Waseem, M., 2021. Epidural hematoma. In StatPearls
[Internet]. StatPearls Publishing.

14. Departemen Bedah RSMH/FK Unsri
Pendidikan Dokter Spesialis-1 Ilmu Bedah
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