Epidural Hematoma Follow-up

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

Further Outpatient Care

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

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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

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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

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Transfer

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

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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.

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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.

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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]

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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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