This document discusses epidural hematoma (EDH), which occurs in 1% of head trauma admissions and is more common in males under age 60. EDH is usually caused by arterial bleeding in the middle meningeal artery. Symptoms include brief loss of consciousness, headache, vomiting, and hemiparesis on the opposite side from the injury. CT scan is the preferred imaging method and will show a biconvex high density lesion near the skull. Small or chronic EDH may be treated medically with observation and steroids, while larger acute EDH generally requires surgical evacuation to prevent herniation. Complications include further bleeding, infection, and permanent brain injury. Outcomes range from full recovery to mortality in 20

1. Dr ANH PHAM NGOC

2. 
 Introdue
 Diagnosis
1. Sign and symptom
2. Imaging
 Treatment
 Complication
 Outcome

3. 
 Incedence of epidural hematoma : 1% of head
trauma admission
 Ratio of male : female = 4:1
 Usually occurs in young adult, rare before age 2 yrs
or after age 60
 Source of bleeding: 85% = arteral bleeding,
remainder from middle meningeal vein or dural
sinus
INTRODUE

4. 
 Brief posttramatic loss of consciousness
 Followered by a “lucid interval” for several hours
 Obtundation, contralateral hemiparesis, ipsilateral
pupillary dilatation
SIGN AND SYMPTOMs

5. 
 Other presenting finding: headache, vomitting,
seizure, hemi-hyperreflexia + unilateral Babinski
sign, and elevated CSF pressure
 Bracdycardia is usually a late finding
 kernohan phenomenon or Kernohan notch
phenomenon

6. 
 Plain skull x-rays: no fracture is identified in 40% of
EDH
 CT scan
1. Occurs in 84% of cases
2. High density biconvex(lenticular) shape adjacent to
the skull
3. An EDH may cross the falx, uniform density, high
attenuation, mass effect
IMAGING

7. 

8. 

9. 

10. 

11. 
 MEDICAL
 Small(≤1cm maximal thickness) subacute or chronic
EDH, with minimal neurological sign/symptoms and
no evidence of herniation
 In 50% of cases there will be a slight transcient
increase in size between days 5-
16→herniation→surgical
 Management : admit, observe, steroids for several
days, then taper.Follow-up CT
TREATMENT

12. 
 Indications for surgery
 EDH volume >30cm3 should be evacuated regardless
of GCS
 Managed non-surgically
 Volume < 30cm3
 And thickness < 15mm
 And with midline shift < 5mm
 And GCS >8
 And no focal neurologic deficit
SURGICAL

13. 
 Timing of surgery
 Patient with an acute EDH and GCS <9 and anisocoria
undergo surgical evacuation ASAP
 Technique :craniotomy, craniectomy

14. 
 In-operate
 Hypotension
 Hypoxia brain
 Post-operate
 Futher bleeding
 Permanent brain injury
 Hydrocephalus
 infection
COMPLICATION

15. 
 Mortality #20%-55%(higher rates in older series)
 Mortality without lucid interval double that with
 Bilateral Babinski or decerebration pre-op →worse
prognosis
 20%EDH on CT also have ASDH at autopsy or
operate
OUTCOME

16. 
 REFERENCE
 Handbook of neurosurgery .Mark S. Greenberg
seventh Edition.
 Hướng dẫn thực hành cấp cứu ngoại thần
kinh.BVCR1998