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Epidural Hematoma Management Guide

Epidural Hematoma (EDH) is a neurosurgical emergency often resulting from trauma, characterized by rapid blood accumulation in the epidural space. Management includes initial trauma assessment, with non-surgical options for smaller hematomas and surgical intervention for larger or symptomatic cases. Recommendations emphasize early nutritional support and the use of phenytoin to prevent seizures, while steroids are not advised.

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Setio Ari Bowo
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90 views11 pages

Epidural Hematoma Management Guide

Epidural Hematoma (EDH) is a neurosurgical emergency often resulting from trauma, characterized by rapid blood accumulation in the epidural space. Management includes initial trauma assessment, with non-surgical options for smaller hematomas and surgical intervention for larger or symptomatic cases. Recommendations emphasize early nutritional support and the use of phenytoin to prevent seizures, while steroids are not advised.

Uploaded by

Setio Ari Bowo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

Management Update in

EPIDURAL HEMATOMA

Imam Hidayat, MD, M.Kes, Ph.D, FINPS


Neurosurgery Division, Department of Surgery
Faculty of Medicine, Universitas Syiah Kuala - Dr. Zainoel Abidin Genreal Hospital
Banda Aceh - Indonesia
Introduction

Epidural Hematoma (EDH)  Neurosurgical emergency,


often following trauma, where blood rapidly collects in the
epidural space and compresses brain parenchyma

< 1% Among patient with head injuries

< 10% Among comatose head injuries patients

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Slide
Imaging & Stage

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Chief Concern

1. Clear fluid running from ear or nose (CSF leak)


2. Black eye with no associated trauma around eye
3. Bleeding from ear
4. New deafness in 1 or both ears
5. Bruising behind 1 or both ears (Battle sign)
6. Visible trauma to scalp or skull
7. History of trauma
8. Coma
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Slide
Clinical Classic Triad

1. Lucid Interval
2. Anisocoria Pupil (Dilatation of Pupil Ipsilateral)
3. Contralateral Hemiparesis

WARNING: Uncal Herniation (Life Threatening)

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Slide
Differential Diagnosis

Healthy Brain EDH SDH ICH

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Slide
Initial & Non-Surgical Management

EDH

Initial trauma assessment & management should be performed in


emergency department - ABC

Consider non-surgical management if:


1. Supratentorial hematoma size < 60 cm3
2. Posterior fossa hematoma size < 30 cm3
3. GCS Score > 9
4. Midline shift < 5 mm
5. No hydrocephalus on CT scan of brain
6. Stable GCS score for 6 hours
7. No change in hematoma size on follow-up CT (6 – 48 hours)
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Slide
Surgical Management

Immediate surgical management recommended if anisocoria

Perform surgical evacuation if:


1. Supratentorial hematoma size > 60 cm3
2. Posterior fossa hematoma size > 30 cm3
3. GCS Score < 9
4. Midline shift > 5 mm
5. Drop in GCS within 6 hours and/or increase hematoma volume

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When to Refer?

No Scan
All Head Injury Cases with Decreased of
Consciousness  Ideally Refer To Neurosurgery
Centre With CT Scan and Operative Facility.

Classic Clinical Triad EDH  Exploratory Burhole


by General Surgeon when Far From Neurosurgery
Centre.

With Scan
Indication for Surgery  Blood Volume > 25 cc or Midline Shift > 5 mm
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Recommendation

Nutrition
• Feeding patients to attain basal caloric replacement at least fifth day post injury
to decrease mortality
• Early nutritional support associated with reduced mortality compared to
delayed feeding
• Parenteral nutrition might be more effective than enteral nutrition

Medication
• Steroid use not recommended for improving outcome or reducing ICP
• Phenytoin recommended to decrease incidence of early posttraumatic seizures
(within 7 days of injury)
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Slide
FACULTY OF MEDICINE
Universitas Syiah Kuala

TERIMONG
GEUNASE

www.fk.usk.ac.id
Banda Aceh - Indonesia

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