Epidural Hematoma

An epidural hematoma (EDH) is a collection of blood inside your skull around your brain. It’s a type of life-threatening brain bleed.

Epidural hematomas happen when a blood vessel in your skull breaks or tears. The broken vessel bleeds into the thick membrane that covers your brain (the dura mater). The blood pools and gets trapped under your dura mater. This puts extra pressure on your brain and can cause serious brain damage.

The dura also covers your spinal cord. Epidural hematomas can happen around your spinal cord, too (spinal epidural hematoma). But an EDH almost always refers to a bleed inside your skull.

Symptoms of an epidural hematoma

When you have an epidural hematoma, you may experience a brief loss of consciousness after head trauma. A period of alertness follows, lasting for several hours. Then, you may have a loss of consciousness with a decline in brain function.

Other signs and symptoms of an EDH include:

• Confusion
• Dizziness
• Nausea and vomiting
• Unequal pupils (the black center of your eye)
• Severe headache
• Slurred speech
• Weakness on one side of your body

If you don’t get treatment right away, the bleeding in your skull can continue to put pressure on your brain and cause more severe symptoms, including:

• Breathing problems
• Seizures
• Loss of brain function
• Coma

An untreated EDH can be fatal if blood puts too much pressure on your brain.

Epidural hematoma causes

Skull fractures are the most common cause of epidural hematomas. Experts estimate that 3 in 4 people who experience an EDH have a skull fracture. Any serious trauma or injury can break your skull, including:

• Car accidents
• Falls
• Sports injuries

Other causes of epidural hematomas are much less common, but can include:

• Blood disorders
• Blood vessel issues, like arteriovenous malformations or cavernous malformations
• Infections that spread to your skull
• Skull or brain tumors

Risk factors

Epidural hematomas are most common in people between the ages of 20 and 30.

Your dura mater is looser and more flexible when you’re a young adult. This can make the blood vessels attached to it more likely to break or tear during an injury. As you age, your dura mater loses some of its flexibility and grows more closely connected to your skull.

How doctors diagnose epidural hematomas

A healthcare provider will diagnose an EDH with imaging tests. They’ll use a CT scan or MRI to take pictures of your skull and brain. You might need an angiogram if your provider thinks you have a hematoma that isn’t from an injury.

Your provider will also do a physical and a neurological exam. You might need a skull X-ray to diagnose a head injury, like a skull fracture.

What are epidural hematoma treatments?

A provider will try to stop the bleeding and drain the built-up blood inside your skull. This may reduce your risk of brain damage.

You’ll probably need surgery to relieve the increased intracranial pressure inside your skull. The two most common EDH surgeries include:

• Craniotomy: Your surgeon removes a piece of your skull to relieve the pressure and vacuum out extra blood in your brain. They replace the section of your skull after the pressure returns to a safe level.
• Trephination (burr hole evacuation): Your surgeon drills a few holes into your skull to let the excess blood drain out. Surgeons typically only do this if they need to act fast to save your life and don’t have time to do a craniotomy.

Occasionally, a small epidural hematoma may not require surgery. Your provider will make sure you’re not in immediate danger and that the EDH isn’t causing any symptoms. You’ll need to stay in the hospital for a few days so they can monitor it.

Your provider will give you follow-up neurological exams and CT scans every few hours to monitor the bleeding. If the hematoma gets bigger, you’ll need surgery to remove it.

Rehab

In most cases, you’ll need at least one kind of rehab therapy after surgery, including:

• Cognitive therapy (to help improve your memory, thinking and other mental abilities)
• Occupational therapy
• Physical therapy
• Speech therapy

How serious is an epidural hematoma?

An epidural hematoma is a very serious, potentially life-threatening condition that requires immediate medical care. Chances of survival increase the faster you get a diagnosis and treatment.

Epidural hematoma survival rate

It’s hard for experts to estimate a survival rate that applies to everyone.

Your outlook will depend on a few factors, including:

• The area of your brain affected
• The severity and size of the EDH
• How soon you get treatment
• Which symptoms you experience
• Your age

Most people recover without long-term complications. Having severe symptoms (especially a coma) can affect your chances of survival. Your healthcare provider will tell you what to expect based on your unique situation.