Epidural hematoma natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
If left untreated, patients with epidural hematoma may progress to develop permanent paraplegia, loss of sensation, brain herniation, coma and death. Common complications of epidural hematoma include: brain herniation, death, post-traumatic seizures, visual problems, persistent paraplegia, Coma, loss of sensation, priapism, disturbed circulation of the cerebrospinal fluid and Urinary retention. Prognosis is generally good in patients treated surgically without delay. In patients with acute epidural hematoma the surgery in an interval under two hours leads to 17% mortality rate and 67% of good recoveries but in patients who recover after an interval of more than two hours the mortality rate is 65% and good recovery rate is 13%. Overall mortality rate of patients with epidural hematoma is approximately 25%. The percentages of overall good recoveries and minimal neurologic deficit in patients with epidural hematoma is approximately 58%. The prognosis is worse in older patients and in patients with concomitant injuries of other body regions.
Natural History, Complications, and Prognosis
Natural History
- If left untreated, patients with epidural hematoma may progress to develop permanent paraplegia, loss of sensation, brain herniation, coma and death.[1][2][3][4][5]
Complications
- Common complications of epidural hematoma include:
- Brain herniation[4]
- Death[6]
- Post-traumatic seizures[7]
- Infarction of the brain tissue which may cause:
- Disturbed circulation of the cerebrospinal fluid[9]
- Urinary retention[10]
Prognosis
- Prognosis is generally good in patients treated surgically without delay.[11]
- In patients with acute epidural hematoma the surgery in an interval under two hours leads to 17% mortality rate and 67% of good recoveries but in patients who recover after an interval of more than two hours the mortality rate is 65% and good recovery rate is 13%.[12]
- Overall mortality rate of patients with epidural hematoma is approximately 25%.[12]
- The percentages of overall good recoveries and minimal neurologic deficit in patients with epidural hematoma is approximately 58%.[12]
- The prognosis is worse in older patients and in patients with concomitant injuries of other body regions.[12]
References
- ↑ 1.0 1.1 1.2 Cuenca PJ, Tulley EB, Devita D, Stone A (2004). "Delayed traumatic spinal epidural hematoma with spontaneous resolution of symptoms". J Emerg Med. 27 (1): 37–41. doi:10.1016/j.jemermed.2004.02.008. PMID 15219302.
- ↑ 2.0 2.1 Anipindi S, Ibrahim N (2017). "Epidural Haematoma Causing Paraplegia in a Patient with Ankylosing Spondylitis: A Case Report". Anesth Pain Med. 7 (2): e43873. doi:10.5812/aapm.43873. PMC 5559664. PMID 28824860.
- ↑ 3.0 3.1 Gogarten W, Hoffmann K, Van Aken H (2010). "[Recommendations for the administration of conventional and new antithrombotic agents from the perspective of anesthesiology]". Unfallchirurg. 113 (11): 908–14. doi:10.1007/s00113-010-1881-x. PMID 21069508.
- ↑ 4.0 4.1 Ben-Israel D, Isaacs AM, Morrish W, Gallagher NC (2017). "Acute vertex epidural hematoma". Surg Neurol Int. 8: 219. doi:10.4103/sni.sni_218_17. PMC 5609442. PMID 28966825.
- ↑ 5.0 5.1 Firsching R (2017). "Coma After Acute Head Injury". Dtsch Arztebl Int. 114 (18): 313–320. doi:10.3238/arztebl.2017.0313. PMC 5465842. PMID 28587706.
- ↑ Chakraborty S, Dey PK, Chatterjee S (2015). "Cranial epidural hematoma related to an accidental fall from mother's lap in a neonate". J Pediatr Neurosci. 10 (1): 82–3. doi:10.4103/1817-1745.154370. PMC 4395959. PMID 25878757.
- ↑ Lee ST, Lui TN (1992). "Early seizures after mild closed head injury". J Neurosurg. 76 (3): 435–9. doi:10.3171/jns.1992.76.3.0435. PMID 1738023.
- ↑ Ulrich PT, Fuessler H, Januschek E (2008). "Acute epidural hematoma with infarction of the right hemisphere in a 5-month-old child: case report with a long-term follow-up and a review of the literature". J Child Neurol. 23 (9): 1066–9. doi:10.1177/0883073808315411. PMID 18827272.
- ↑ Fuchs EC, Müller-Busch C, Amtenbrink V (1975). "[Prognosis and long-term prognosis of epidural haematoma (a study of 83 patients) (author's transl)]". Rehabilitation (Stuttg). 14 (2): 82–7. PMID 1233608.
- ↑ Sakakibara R, Yamazaki M, Mannouji C, Yamaguchi C, Uchiyama T, Ito T; et al. (2008). "Urinary retention without tetraparesis as a sequel to spontaneous spinal epidural hematoma". Intern Med. 47 (7): 655–7. PMID 18379155.
- ↑ Jung SW, Kim DW (2012). "Our experience with surgically treated epidural hematomas in children". J Korean Neurosurg Soc. 51 (4): 215–8. doi:10.3340/jkns.2012.51.4.215. PMC 3377878. PMID 22737301.
- ↑ 12.0 12.1 12.2 12.3 Haselsberger K, Pucher R, Auer LM (1988). "Prognosis after acute subdural or epidural haemorrhage". Acta Neurochir (Wien). 90 (3–4): 111–6. PMID 3354356.