Extradural hematoma; Epidural hematoma
An extradural hemorrhage is an emergency condition! Treatment goals include taking measures to save the person's life, controlling symptoms, and minimizing or preventing permanent damage to the brain.
Life support measures may be required. Emergency surgery is almost always necessary to reduce pressure within the brain. This may include drilling a small hole in the skull to relieve pressure and allow drainage of the blood from the brain.
Medications used in addition to surgery will vary according to the type and severity of symptoms and brain damage that occurs.
Anticonvulsant medications (such as phenytoin) may be used to control or prevent seizures. Some medications called "hyperosmotic agents" (like mannitol, glycerol, and hypertonic saline) may be used to reduce brain swelling.
An extradural hemorrhage has a high risk of death without prompt surgical intervention. Even with prompt medical attention, a significant risk of death and disability remains.
There is a risk of permanent brain injury whether the disorder is treated or untreated. Symptoms (such as seizures) may persist for several months, even after treatment, but in time they usually become less frequent or disappear completely. Seizures may begin as many as 2 years after the injury.
In adults, most recovery occurs in the first 6 months, with some improvement over approximately 2 years. Children usually recover more quickly and completely than adults.
Incomplete recovery is the result of brain damage. Other complications include permanent symptoms (such as paralysis or loss of sensation, which began at the time of the injury), herniation of the brain (which may result in permanent coma), and normal pressure hydrocephalus (excess fluid in the cavities of the brain).
Go to the emergency room or call 911 if symptoms of extradural hemorrhage occur.
Spinal injuries often occur with head injuries, so if you must move the person before help arrives, try to keep his or her neck still.
Call your health care provider if symptoms persist after treatment, including memory loss, difficulty maintaining attention, dizziness, headache, anxiety, speech difficulties, and complete or partial loss of movement in part of the body.
Go to the emergency room or call 911 if emergency symptoms develop after treatment, including breathing difficulties, convulsions/seizures, decreased responsiveness, loss of consciousness, enlarged pupils, and uneven pupil size.
Biros MH, Heegaard WG. Head injury. In: Marx JA, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 38.
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