Signs
An epidural hematoma is a hemorrhage that forms between the dura mater and the bones of the skull, and is most often the result of a traumatic brain injury. If the patient is available for verbal contact, the first complaints will be a headache that increases, and may later be accompanied by vomiting.
Light gap
One of the main signs of epidural hemorrhage is the so-called lucid interval, a period of time lasting from 30 minutes to several hours, characterized by loss of consciousness followed by complete recovery.
Other complaints that a patient may have are:
- dizziness,
- general weakness,
- memory impairment.
After the end of the above-mentioned light interval , the patient’s condition deteriorates sharply – the headache intensifies , nausea and vomiting appear, clear consciousness is progressively replaced by a disorder of consciousness up to a coma with:
- decrease or increase in pulse,
- increased blood pressure,
- pupil dilation on the side of the hematoma,
- weakness in the limbs on the side opposite the hematoma.
After coma occurs, severe disorders of vital functions occur.
Erased light period
Sometimes an epidural hematoma occurs with an erased lucid period, that is, after the injury there is a deep disturbance of consciousness up to a coma, then after a few hours the coma changes to a stupor, in which even verbal contact with the patient is possible. This state can last from an hour to a day. Then again, a decrease in the level of consciousness to a coma with a violation of the body’s vital functions can be observed.
No light period
Epidural hematomas without a clear period are less common. This occurs in severe head injuries with damage to the brain substance. Coma occurs immediately after the injury and is not accompanied by an increase in the level of consciousness.
Diagnostics
Computed tomography (CT) is the main diagnostic method that allows for the most accurate diagnosis of this pathology, which in the images will have the shape of a biconvex lens.
Treatment
The Neurosurgical Department in Ternopil provides emergency neurosurgical care to patients with epidural hematomas.
Conservative treatment is carried out in cases where the hematoma is not accompanied by the development of neurological symptoms, without signs of brain compression and dislocation of the median structures. In this case, patients are under constant dynamic monitoring with determination of the volume of the hematoma according to CT data, control of blood pressure and saturation. When neurological symptoms develop, a decrease in the level of consciousness occurs, there are data on compression and dislocation of the median structures of the brain, urgent neurosurgical intervention is performed with trepanation of the skull and removal of the epidural hematoma with stopping the bleeding. Upon completion, the removed bone flap can either be installed in place of the bone defect, or hemmed into the subcutaneous fat of the anterior abdominal wall (after stabilization of the condition, plastic surgery of the defect is performed with the preserved bone flap).
Forecast
Mortality in this pathology is up to 40%, and surviving patients often have neurological deficits.
Rehabilitation
After surgery, patients receive a course of rehabilitation treatment :
- therapeutic exercise,
- massage,
- electrical stimulation of limb muscles.