Epidural Hemorrhage

What is Epidural Hemorrhage

Epidural hemorrhage is a type of traumatic brain injury (TBI). It happens if bleeding occurs between the inside of the skull bone and the outer membrane that covers the brain (dura mater).

As the amount of bleeding increases, the blood puts pressure on the brain. This can cause the affected part of the brain to stop working, and it may eventually cause death. An epidural hemorrhage is a medical emergency.

What are the causes?

This condition is caused by bleeding from a broken (ruptured) blood vessel. In most cases, a blood vessel ruptures and bleeds because of injury (trauma) to the head. Head trauma can happen in:

• Traffic accidents.
• Falls.
• Assaults.
• Sport injuries.

Less commonly, an epidural hemorrhage can happen without head trauma. In these cases, bleeding may be caused by:

• An infection.
• A tumor.
• A bleeding disorder, such as hemophilia.

What increases the risk?

This condition is more likely to develop in people who:

• Participate in sports in which a head injury is possible. These include boxing, football, soccer, hockey, auto or bicycle racing, downhill skiing, and horseback riding.
• Take risks while driving or riding in a motor vehicle, such as speeding.
• Are at risk for falls.
• Take blood thinners (anticoagulants), including aspirin or warfarin.
• Have a bleeding disorder.
• Abuse drugs or alcohol.

What are the signs or symptoms?

Symptoms of this condition may include:

• A severe headache or a headache that steadily gets worse.
• Nausea or vomiting.
• Dizziness.
• Drowsiness.
• A temporary decrease in alertness.
• Loss of consciousness.
• Confusion.
• Changes in speech or difficulty speaking.
• Seizures.
• An inability to move an arm or a leg on one side of the body.

Symptoms may develop immediately or several hours after a head injury.

How is this diagnosed?

This condition may be diagnosed based on your symptoms, your medical history, and a physical exam. You may have tests, including:

• Blood tests.
• A CT scan.
• MRI.

How is this treated?

This condition is a medical emergency that must be treated in a hospital immediately. Treatment depends on the cause, severity, and duration of your symptoms. The goals of treatment are to stop the bleeding, reduce pressure on the brain, and relieve symptoms. Treatment may include:

• Medicines that:
  • Lower blood pressure (antihypertensives).
  • Relieve pain (analgesics).
  • Relieve nausea and vomiting.
  • Control seizures.
  • Reduce swelling in the brain.
  • Control bleeding.
• Assisted breathing (ventilation). This involves using a machine called a ventilator to help you breathe.
• Giving donated blood products through an IV tube (transfusion). You will receive cells that help your blood clot.
• Placing a tube (shunt) in the brain to relieve pressure.
• Performing surgery. This may be needed to stop bleeding, remove blood, or reduce pressure on the brain.

Follow these instructions at home:

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• If you play a contact sport and you experience a head injury, follow advice from your health care provider about when you can return to the sport.
• Rest. Rest helps the brain to heal. Make sure you:
  • Get plenty of sleep. Avoid staying up late at night.
  • Keep a consistent sleep schedule. Try to go to sleep and wake up at about the same time every day.
  • Avoid activities that cause physical or mental stress.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do notdrive or operate heavy machinery until your health care provider approves.
• Limit alcohol intake to no more than 1 drink per day for nonpregnant women and 2 drinks per day for men. One drink equals 12 oz of beer, 5 oz of wine, or 1½ oz of hard liquor.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Wear protective gear, such as helmets, when participating in activities such as biking or contact sports.
• Always wear a seat belt when you are in a motor vehicle.
• Keep your home environment safe to reduce the risk of falling.

Contact a health care provider if:

You develop any of the following symptoms after your injury:

• Headaches that keep coming back (chronicheadaches).
• Dizziness or balance problems.
• Nausea.
• Vision problems.
• Increased sensitivity to noise or light.
• Depression or mood swings.
• Anxiety or irritability.
• Memory problems.
• Difficulty concentrating or paying attention.
• Sleep problems.
• Feeling tired all the time.

Recovery from brain injuries varies widely. Talk with your health care provider about what to expect during your recovery.

Get help right away if:

• You develop signs of an epidural hemorrhage, such as:
  • A severe headache or a headache that steadily gets worse.
  • Nausea or vomiting.
  • Drowsiness.
  • Dizziness.
  • A temporary decrease in alertness.
  • Loss of consciousness.
  • Confusion.
  • Changes in your speech or difficulty speaking.
  • Seizure.
  • Inability to move your arm or your leg on one side of your body.
• You are taking blood thinners and you fall or you experience minor trauma to the head.
• You have a bleeding disorder and you fall or you experience minor trauma to the head.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.