An epidural hematoma is a collection of blood between the inner surface of the skull and the dura mater — the brain’s outer protective layer.
It usually results from a head injury, often involving a skull fracture that tears an artery, most commonly the middle meningeal artery.
Epidural hematoma is a neurosurgical emergency: rapid diagnosis and immediate surgical evacuation can be life-saving.
With timely treatment, patients often make a full recovery.
Symptoms
Symptoms of an epidural hematoma can develop rapidly — sometimes after a short “lucid interval” where the patient appears well before deteriorating.
Typical symptoms include:
- Loss of consciousness at the time of injury, followed by temporary recovery and then rapid decline
- Severe headache, nausea, or vomiting
- Drowsiness, confusion, or irritability
- Weakness or paralysis on one side of the body (opposite to the bleeding)
- Dilated pupil on the same side as the hematoma (from cranial nerve compression)
- Seizures or abnormal posturing in severe cases
Without urgent intervention, epidural hematoma can lead to brain herniation and death.
Diagnosis
Diagnosis begins with a thorough neurological examination assessing level of consciousness and pupil response.
The CT scan of the head is the gold standard — showing a biconvex (lens-shaped) hyperdense area between the skull and dura.
The hematoma often occurs in the temporal or parietal region, sometimes accompanied by a skull fracture visible on CT bone windows.
MRI may be used in selected cases to evaluate brain injury or subacute hematomas.
Continuous monitoring of Glasgow Coma Scale (GCS) and vital signs is essential throughout diagnosis and treatment.
Treatment Options
1. Emergency Surgical Evacuation (Craniotomy / Burr Hole)
The primary treatment for significant epidural hematoma is urgent surgical removal of the clot.
- Craniotomy: The bone flap is temporarily removed to evacuate the hematoma and control bleeding from the torn vessel.
- Burr hole drainage: In emergency or remote settings, a burr hole may be made to relieve pressure before definitive surgery.
Surgery aims to relieve brain compression, control bleeding, and restore normal intracranial pressure.
2. Conservative (Non-Surgical) Management
Small hematomas (<30 ml) without neurological deficits and stable patients may be observed with close neurological monitoring and serial CT scans.
If the hematoma enlarges or symptoms progress, immediate surgery is indicated.
3. Intensive Care and Supportive Management
After surgery, patients are monitored in the neurointensive care unit (NICU) for intracranial pressure control, seizure prophylaxis, and neurological observation.
Additional care includes maintaining normal blood pressure, oxygenation, and glucose levels to optimize brain recovery.
Recovery & Follow-Up
After successful evacuation, neurological improvement is often rapid.
Patients typically stay in the hospital for 5–7 days, depending on severity.
Follow-up CT scans confirm hematoma resolution and absence of reaccumulation.
Rehabilitation, if needed, focuses on motor recovery, balance, and cognition.
In uncomplicated cases, patients usually regain full function within weeks.
Prognosis
With early surgical intervention, the prognosis of epidural hematoma is excellent.
Delayed diagnosis or missed “lucid interval” can lead to severe brain injury or fatal outcomes.
Prognosis is strongly linked to initial GCS score, hematoma size, and speed of decompression.
When to Seek Emergency Help
If a head injury is followed by loss of consciousness, vomiting, unequal pupils, or worsening confusion, seek immediate medical attention.
Epidural hematoma is a true emergency — every minute counts in preserving brain function and life.