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Epidural hematoma

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High Yield Notes

18 pages

Flashcards

Epidural hematoma

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Questions

USMLE® Step 1 style questions USMLE

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A 30-year-old woman is brought to the emergency department following a fall during a climbing trip. Her partner, who accompanied her, reports that the patient fell from a 4-meter height and hit her head. En route to the hospital, the patient is comatose and unresponsive. Glasgow Coma Score is 3. She is sedated and intubated. On arrival, her temperature is 36.0°C (96.8°F), pulse is 43/min, respirations are 7/min and irregular, and blood pressure is 200/70 mmHg. On physical examination, her arms are stiff and bent, with clenched fists and outstretched legs. Both pupils are fixed and dilated. A non-contrast CT is obtained and shows a large biconvex-shaped lesion. Which of the following additional findings is most likely to be present?  

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First Aid

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Epidural hematomas p. 528

Middle meningeal artery

epidural hematoma and p. 528

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Transcript

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Content Reviewers

Rishi Desai, MD, MPH,Yifan Xiao, MD

Epidural hemorrhage can be broken down. "Epi" means above, "dural" refers to the outermost protective layer of the brain, which is called dura mater and and “hemorrhage” refers to bleeding.

So, an epidural hemorrhage is when there’s bleeding above the dura mater.

OK - let’s start with some basic brain anatomy. The brain is protected by the meninges, which are 3 thin layers of tissue which cover the brain and spinal cord.

The inner layer of the meninges is the pia mater, the middle layer is the arachnoid mater, and the outer layer is the dura mater.

The pia and arachnoid maters, are also called leptomeninges.

Between the leptomeninges, there’s the subarachnoid space, which houses cerebrospinal fluid, or CSF.

CSF is a clear, watery liquid which is pumped around the spinal cord and brain, cushioning them from impact and bathing them in nutrients.

The outer membrane, the dura mater consists of two layers.

The internal layer of the dura mater lies above the arachnoid mater - the two are separated by the subdural space.

The external layer of the dura mater adheres to the inner surface of the skull.

These two layers of the dura mater travel together, but at certain spots, the internal layer of the dura mater separates from the external one to form the meningeal folds.

The meningeal folds help divide the sections of the brain like the falx cerebri which separates the two hemispheres of the cerebrum, and the tentorium, which covers the cerebellum and separates it from the cerebrum.

Summary

An epidural hematoma is a collection of blood above the dural mater, usually due to a head trauma. When blood accumulates in this space, it can result in raised intracranial pressure, damaging delicate nerve cells.

Epidural hematomas are most commonly caused by head injuries, such as those sustained in car accidents or falls. They can also be associated with childbirth (in newborns), cancer, or certain medical procedures. Symptoms vary depending on the size and location of the hematoma, but may include a headache, nausea and vomiting, loss of consciousness, seizures, or paralysis.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Pediatric head trauma" Journal of Emergencies, Trauma, and Shock (2011)
  6. "Surgical management of head trauma" Neuroimaging Clinics of North America (2002)
  7. "Emergency Department Skull Trephination for Epidural Hematoma in Patients Who Are Awake But Deteriorate Rapidly" The Journal of Emergency Medicine (2010)