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Epidural Hematoma Medication

  • Author: David S Liebeskind, MD; Chief Editor: Helmi L Lutsep, MD  more...
 
Updated: Apr 08, 2014
 

Medication Summary

Osmotic diuretics, such as mannitol or hypertonic saline, may be used to diminish intracranial pressure. As hyperthermia may exacerbate neurological injury, acetaminophen may be given to reduce fevers. Anticonvulsants are used routinely to avoid seizures that may be induced by cortical damage. Patients with spinal epidural hematoma may require high-dose methylprednisolone when spinal cord compression is involved. Immobilized patients may require heparin for prevention of venous thrombosis, whereas vitamin K and protamine may be administered to restore normal coagulation parameters. Antacids are used to prevent gastric ulcers associated with traumatic brain injury and spinal cord damage.

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Osmotic diuretics

Class Summary

These agents reverse the pressure gradient across the blood-brain barrier, reducing intracranial pressure.

Mannitol (Osmitrol, Resectisol)

 

Reduces cerebral edema by osmotic forces and decreases blood viscosity, resulting in reflex vasoconstriction and lowering of intracranial pressure.

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Antipyretic agents

Class Summary

These agents are helpful in relieving the fever associated with the condition.

Acetaminophen (Tylenol, Feverall, Aspirin Free Anacin)

 

Reduces fever and maintains normothermia. DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, or who are taking oral anticoagulants.

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Anticonvulsants

Class Summary

These agents reduce frequency of early posttraumatic seizures from 14% to 4%, but they do not prevent later seizures. If seizures are not experienced for 7-10 d, the drug may be discontinued.

Fosphenytoin (Cerebyx)

 

Converted to phenytoin, which modulates neuronal voltage-dependent sodium channels.

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Corticosteroids

Class Summary

Anti-inflammatory properties mitigate tissue damage in spinal cord compression.

Methylprednisolone (Adlone, Medrol, Solu-Medrol)

 

Reduces injury associated with spinal cord compression. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

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Antidotes

Class Summary

These agents reverse some coagulopathies or bleeding diatheses.

Phytonadione; vitamin K (AquaMEPHYTON, Konakion, Mephyton)

 

Promotes hepatic synthesis of clotting factors that inhibit warfarin effects.

Protamine

 

Neutralizes effects of heparin.

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Antacids

Class Summary

These agents provide prophylaxis of gastric ulcers.

Famotidine (Pepcid)

 

Competitively inhibits histamine at H2 receptor of gastric parietal cells, resulting in reduced gastric acid secretion, gastric volume, and hydrogen concentrations. Minimizes development of gastric ulcers.

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Anticoagulants

Class Summary

These agents reduce risk of venous complications in immobilized patients.

Heparin

 

Augments activity of antithrombin III and prevents conversion of fibrinogen to fibrin. Does not actively lyse but is able to inhibit further thrombogenesis. Prevents re-accumulation of clot after spontaneous fibrinolysis. Used for prophylaxis of deep venous thrombosis.

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Contributor Information and Disclosures
Author

David S Liebeskind, MD Professor of Neurology, Program Director, Vascular Neurology Residency Program, University of California, Los Angeles, David Geffen School of Medicine; Neurology Director, Stroke Imaging Program, Co-Medical Director, Cerebral Blood Flow Laboratory, Associate Neurology Director, UCLA Stroke Center

David S Liebeskind, MD is a member of the following medical societies: American Academy of Neurology, Stroke Council of the American Heart Association, American Heart Association, American Medical Association, American Society of Neuroimaging, American Society of Neuroradiology, National Stroke Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Howard S Kirshner, MD Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center

Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Neurological Association, American Society of Neurorehabilitation, American Academy of Neurology, American Heart Association, American Medical Association, National Stroke Association, Phi Beta Kappa, Tennessee Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD Professor and Vice Chair, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, OHSU Stroke Center

Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology, American Stroke Association

Disclosure: Medscape Neurology Editorial Advisory Board for: Stroke Adjudication Committee, CREST2.

Additional Contributors

Edward L Hogan, MD Professor, Department of Neurology, Medical College of Georgia; Emeritus Professor and Chair, Department of Neurology, Medical University of South Carolina

Edward L Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, Society for Neuroscience, American Society for Biochemistry and Molecular Biology, American Academy of Neurology, American Neurological Association, Phi Beta Kappa, Sigma Xi, Southern Clinical Neurological Society

Disclosure: Nothing to disclose.

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CT scanning performed before and after surgical evacuation of an intracranial epidural hematoma.
This MRI demonstrates spinal epidural hematoma.
 
 
 
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