What are Subdural and Epidural Hematomas?
A severe head trauma due to a falling incident, a motor vehicle collision, or a sporting accident can possibly result in the rupturing of a blood vessel in the brain, leading to bleeding in the brain. This accumulation of blood inside the skull is referred to as an intracranial hematoma. Epidural and subdural hematomas are two different kinds of intracranial hematomas.
A subdural hematoma is defined as an accumulation of blood between the dura mater (the protective covering of the brain) and the surface of the brain.
An epidural hematoma is defined as bleeding within the skull but outside the dura membrane.
Causes of Subdural and Epidural Hematomas
The causes of subdural and epidural hematomas are quite diverse and may include:
- Motor vehicle accidents
- Sports injuries
- Domestic violence
- Gunshot wounds
- Violent blow
- Jolt to the head
Signs and Symptoms of Subdural and Epidural Hematomas
The bleeding caused by subdural and epidural hematomas can result in the formation of a mass within the skull that can press on brain tissue causing a wide variety of symptoms such as:
- Loss of consciousness
- Ringing in the ears
- Physical weakness
- Difficulty with speech
- Changes in vision
- Memory loss
Risk Factors for Subdural and Epidural Hematomas
You are at risk of developing a subdural or epidural hematoma if you:
- Belong to an advanced age category
- Do not wear a protective helmet during sports activities
- Do not put a seatbelt on while driving
- Drink too much alcohol, which increases the likelihood of falls
- Are taking blood-thinning medications
- Are an athlete involved in contact sports
- Are a hemophiliac (have inherited bleeding disorder)
Diagnosis of Subdural and Epidural Hematomas
In order to diagnose a subdural or epidural hematoma, your physician will conduct a thorough physical examination and a review of your medical history. A neurological exam is also conducted which involves vision testing, blood pressure checks, memory checks, reflex tests, as well as balance and strength testing. A complete blood count test may also be ordered to check for appropriate blood cell count levels.
If these tests indicate the likelihood of an intracranial hematoma, then your physician may order imaging studies such as CT and MRI scans for a detailed evaluation of the skull and soft tissues of the brain and confirm the diagnosis.
Treatment for Subdural and Epidural Hematomas
Treatment for intracranial hematomas depends upon the symptoms and severity of your condition and may involve:
- Home care: To help speed up your recovery post injury, your physician will likely encourage you to follow a treatment plan, rest adequately, refrain from alcohol, refrain from contact sports, gradually increase activity level, and order regular imaging tests to monitor the status of the hematoma.
- Medications: Your physician may employ medications such as hypertonic saline, glycerol, and mannitol to alleviate intracranial pressure and reduce inflammation. Your physician may also order anti-seizure medications for management of seizure symptoms - a potential complication of a head injury.
- Rehabilitative therapy: Your physician may refer you to a suitable therapist to manage symptoms such as weakness, difficulty walking, incontinence, or loss of sensation/paralysis.
- Surgery: In most cases, surgical intervention with a procedure called a craniotomy is the choice of treatment for removal of the hematoma. In this procedure, your surgeon will cut open a section of your skull under anesthesia and remove the hematoma to decrease the pressure on your brain. In other cases, your surgeon may recommend a procedure called aspiration in which your surgeon drills a small hole on the skull under anesthesia and then utilizes suction and irrigation to remove the hematoma. This method may only be effective for hematomas that are very small and are not putting pressure on the brain.