eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Epidural Hematoma: Differential Diagnoses & Workup

Author: Daniel D Price, MD, Director of Ultrasound Fellowship, Department of Emergency Medicine, Highland General Hospital, Alameda County Medical Center
Coauthor(s): Sharon R Wilson, MD, Assistant Professor of Emergency Medicine, Department of Emergency Medicine, University of California at Davis Medical Center
Contributor Information and Disclosures

Updated: Nov 18, 2009

Differential Diagnoses

Subarachnoid Hemorrhage
Subdural Hematoma

Other Problems to Be Considered

Cerebral contusion
Diffuse axonal injury

Workup

Laboratory Studies

  • Perform appropriate laboratory work for associated trauma.
  • Coagulation abnormalities are a marker of severe head injury. Breakdown of the blood-brain barrier with exposed brain tissue is a potent cause of disseminated intravascular coagulation (DIC).

Imaging Studies

  • Head CT scan
    • Immediate unenhanced CT scan is the procedure of choice for diagnosis.
    • Head CT scan shows location, volume, effect, and other potential intracranial injuries.
    • Epidural hematoma (EDH) forms an extraaxial, smoothly marginated, lenticular, or biconvex homogenous density.
    • EDH rarely crosses the suture line because the dura is attached more firmly to the skull at sutures.
    • Focal isodense or hypodense zones within EDH indicate active bleeding.
    • Irregular hypodense swirling indicates active bleeding in the majority of patients.
    • Air in acute EDH suggests fracture of sinuses or mastoid air cells.
    • At surgery or autopsy, 20% of patients have blood in both epidural and subdural spaces.

Other Tests

  • Cervical spine evaluation usually is necessary because of the risk of neck injury associated with EDH.

Procedures

  • Perform burr hole(s) if the following occur:
    • Patient is herniating
    • All other treatments prove insufficient
    • Neurosurgery is unavailable for urgent consultation
    • Trephination (or placement of a Burr hole) should ideally be performed if possible by the consulting neurosurgeon at the receiving trauma center
    • Air or ground medical transport is prolonged
  • Burr hole procedure includes the following:
    • Drill hole adjacent to, but not over, skull fracture or in the area located by CT scan.
    • In the absence of CT scan, place a burr hole on the side of the dilated pupil, 2 finger widths anterior to tragus of ear and 3 finger widths above.

More on Epidural Hematoma

Overview: Epidural Hematoma
Differential Diagnoses & Workup: Epidural Hematoma
Treatment & Medication: Epidural Hematoma
Follow-up: Epidural Hematoma
Multimedia: Epidural Hematoma
References
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References

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  2. [Guideline] Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS. Guidelines for the management of severe traumatic brain injury. I. Blood pressure and oxygenation. J Neurotrauma. 2007;24 Suppl 1:S7-13. [Medline]. [Full Text].

  3. [Guideline] Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS. Guidelines for the management of severe traumatic brain injury. II. Hyperosmolar therapy. J Neurotrauma. 2007;24 Suppl 1:S14-20. [Medline]. [Full Text].

  4. [Guideline] Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS. Guidelines for the management of severe traumatic brain injury. IV. Infection prophylaxis. J Neurotrauma. 2007;24 Suppl 1:S26-31. [Medline]. [Full Text].

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Further Reading

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Keywords

epidural hematoma, epidural hematoma causes, epidural hematoma symptoms, epidural hematoma treatment, traumatic brain injury, EDH, head injury, extradural hemorrhage, blood between the skull and dura mater

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Contributor Information and Disclosures

Author

Daniel D Price, MD, Director of Ultrasound Fellowship, Department of Emergency Medicine, Highland General Hospital, Alameda County Medical Center
Daniel D Price, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Sharon R Wilson, MD, Assistant Professor of Emergency Medicine, Department of Emergency Medicine, University of California at Davis Medical Center
Sharon R Wilson, MD is a member of the following medical societies: American Association of University Women, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Robert M McNamara, MD, FAAEM, Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine
Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eric L Legome, MD, Chair, Department of Emergency Medicine, St Vincent's Hospital Manhattan; Associate Professor, Department of Emergency Medicine, New York Medical College
Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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