Further Outpatient Care

After hospital discharge, continued physical, occupational, and speech therapy may be required.

Further Inpatient Care

Following initial management in the emergency department, the patient may be sent for emergent neurosurgical evacuation of the hematoma or may be transferred to the ICU for further care. Subsequent care generally includes the following:

Serial neurologic examinations
Treatment of elevated intracranial pressure
Avoidance of hypotension or hypertension (ie, maintain mean arterial pressure [MAP] between 70-130 mm Hg)
Use of isotonic solutions, such as normal saline, to minimize cerebral edema
Avoidance of hyperthermia
Treatment or prevention of posttraumatic seizures
Observation and potential repair of CSF leaks
Treatment of urinary tract infections
Prevention of venous thrombosis
Prophylaxis for gastric ulcers
Physical, occupational, and speech therapy
Repeat CT scan for clinical deterioration

Inpatient & Outpatient Medications

See the list below:

Mannitol or other osmotic diuretics for elevated intracranial pressure
Steroids for spinal cord compression
Acetaminophen for fever
Subcutaneous heparin for prevention of venous complications
Famotidine or other antacids for gastric ulcer prophylaxis
Fosphenytoin or other anticonvulsants for posttraumatic seizures
Anticholinergics for bladder complications
Baclofen, diazepam, or tizanidine for spasticity due to spinal cord damage
Amitriptyline, carbamazepine, or gabapentin for neuropathic pain

Transfer

Although emergent decompression of an epidural hematoma should not be delayed, trauma patients should be transferred to centers with neurosurgical expertise.

Deterrence/Prevention

Educate the public regarding traumatic brain injury, including appropriate use of safety equipment, precautions, and measures that may reduce the incidence of head injury.

Avoid lumbar puncture or epidural anesthesia in individuals on anticoagulation, following thrombolysis, or when a bleeding diathesis is suspected.

Complications

Neurological deficits or death may occur.

Posttraumatic seizures due to cortical damage may develop 1–3 months after the initial injury, with decreasing frequency over time. Alcoholism increases the risk of posttraumatic seizures.

Delayed effects of an epidural hematoma include the postconcussion syndrome, which is characterized by headaches, dizziness, vertigo, restlessness, emotional lability, inability to concentrate, and fatigue.

Spinal epidural hematoma may cause spasticity, neuropathic pain, and urinary complications.

Prognosis

See the list below:

Declines with advancing age
Deteriorates when associated with other intracranial injuries
Depends on the initial Glasgow Coma Scale score (0% mortality for awake patients, 40% mortality for comatose individuals)
Worsens with delays between injury and surgical intervention
In spinal epidural hematoma, the MRI appearance of T2-hyperintensity within the spinal cord may portend a poor clinical outcome.^[11]

Patient Education

Educate patients regarding prevention of traumatic brain injury, with particular emphasis on sports injuries, use of safety precautions, and proper use of safety equipment.

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Media Gallery

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

of 2

Author

David S Liebeskind, MD, FAAN, FAHA, FANA Professor of Neurology and Director, Neurovascular Imaging Research Core, Director, Vascular Neurology Residency Program, Department of Neurology, University of California, Los Angeles, David Geffen School of Medicine; Director, UCLA Outpatient Stroke and Neurovascular Programs; Director, UCLA Cerebral Blood Flow Laboratory; Associate Neurology Director, UCLA Stroke Center

David S Liebeskind, MD, FAAN, FAHA, FANA is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Medical Association, American Society of Neuroimaging, American Society of Neuroradiology, National Stroke Association, Stroke Council of the American Heart 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; Physician Advisory Board for Coherex Medical; National Leader and Steering Committee Clinical Trial, Bristol Myers Squibb; Abbott Laboratories, advisory group.

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, The Scientific Research Honor Society, Southern Clinical Neurological Society

Disclosure: Nothing to disclose.