Epidural Hematoma Clinical Presentation

Updated: Jan 09, 2018
  • Author: David S Liebeskind, MD, FAAN, FAHA, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Presentation

History

Epidural hematoma should be suspected in any individual who sustains head trauma. Although classically associated with a lucid interval between the initial loss of consciousness at the time of impact and a delayed decline in mental status (10–33% of cases), alterations in the level of consciousness may have a variable presentation. Posterior fossa epidural hematoma may exhibit a rapid and delayed progression from minimal symptoms to even death within minutes.

Symptoms of epidural hematoma include the following:

  • Headache

  • Nausea/vomiting

  • Seizures

  • Focal neurologic deficits (eg, visual field cuts, aphasia, weakness, numbness)

Spinal epidural hematoma typically causes severe localized back pain with delayed radicular radiation that may mimic disk herniation. Associated symptoms may include the following:

  • Weakness

  • Numbness

  • Urinary incontinence

  • Fecal incontinence

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Physical

The physical examination should include a thorough evaluation for evidence of traumatic sequelae and associated neurological deficits, including the following:

  • Bradycardia and/or hypertension indicative of elevated intracranial pressure

  • Skull fractures, hematomas, or lacerations

  • Cerebrospinal fluid (CSF) otorrhea or rhinorrhea resulting from skull fracture with disruption of the dura

  • Hemotympanum

  • Instability of the vertebral column

  • Alteration in level of consciousness (ie, Glasgow Coma Scale score; see the Glasgow Coma Scale calculator)

  • Anisocoria (eg, ipsilateral dilation of the pupil due to uncal herniation with compression of the oculomotor nerve)

  • Facial nerve injury

  • Weakness (eg, contralateral hemiparesis due to compression of the cerebral peduncle)

  • Other focal neurological deficits (eg, aphasia, visual field defects, numbness, ataxia)

Spinal epidural hematoma may have variable findings on physical examination, determined by the level of the lesion. The findings include the following:

  • Weakness (unilateral or bilateral)

  • Sensory deficits with radicular paresthesias (unilateral or bilateral)

  • Various alterations in reflexes

  • Alterations of bladder or anal sphincter tone

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Causes

Potential causes of epidural hematoma include the following:

  • Trauma

  • Anticoagulation

  • Thrombolysis

  • Epidural anesthesia

  • Coagulopathy or bleeding diathesis

  • Hepatic disease with portal hypertension

  • Cancer

  • Vascular malformation

  • Disk herniation

  • Paget disease of bone

  • Valsalva maneuver

  • Hypertension

  • Chiropractic manipulation [4]

  • Acupuncture [5]

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