Extradural hematoma EDH , also known as an epidural hematoma , is a collection of blood that forms between the inner surface of the skull and outer layer of the dura , which is called the endosteal layer. They are usually associated with a history of head trauma and frequently associated skull fracture. The source of bleeding is usually arterial, most commonly from a torn middle meningeal artery. EDHs are typically biconvex in shape and can cause a mass effect with herniation. They are usually limited by cranial sutures, but not by venous sinuses.
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Differentiating extradural EDH from subdural SDH hemorrhage in the head is usually straightforward, but occasionally it can be challenging. SDHs are more common and there are a few distinguishing features which are usually reliable. The typical presentation is of a young patient involved in a head strike either during sport or a result of a motor vehicle accident who may or may not lose consciousness transiently.
Following the injury they regain a normal level of consciousness lucid interval , but usually have an ongoing and often severe headache. Over the next few hours they gradually lose consciousness. In adults SDHs are due to falls and there may not be a clear history of trauma. In young children, non accidental injury is a significant cause.
The patients level of consciousness gradually decreases with increasing mass effect and confusion is often encountered in the elderly. Almost always arterial explaining the progressive growth of the hematoma. Classically due to injury of the middle meningeal artery , a branch of the maxillary artery from the ECA.
Almost always venous due to tearing of subdural cortical bridging veins which extend to the dural sinuses. Typically lentiform lens-shaped, biconvex, lemon-shaped and do not cross sutures as the periosteum crosses through the suture continuous with the outer periosteal layer. As these occur in the subdural space, they cross sutures. SDH has various management strategies depending on the size, location and extent of mass effect and is either conservative monitor with serial CT or surgical drainage with burr holes.
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NCBI Bookshelf. Ali Khairat ; Muhammad Waseem. Authors Ali Khairat 1 ; Muhammad Waseem 2. An epidural hematoma EDH is an extra-axial collection of blood within the potential space between the outer layer of the dura mater and the inner table of the skull. It is confined by the lateral sutures especially the coronal sutures where the dura inserts.
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A subdural hematoma SDH is a type of bleeding in which a collection of blood —usually associated with a traumatic brain injury —gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. It usually results from tears in bridging veins that cross the subdural space. Subdural hematomas may cause an increase in the pressure inside the skull , which in turn can cause compression of and damage to delicate brain tissue. Acute subdural hematomas are often life-threatening. Chronic subdural hematomas have a better prognosis if properly managed. In contrast, epidural hematomas are usually caused by tears in arteries , resulting in a build-up of blood between the dura mater and the skull. The third type of brain hemorrhage, known as a subarachnoid hemorrhage , causes bleeding into the subarachnoid space between the arachnoid mater and the pia mater.