Epidural hematoma physical examination
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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
Findings in physical examination of patients with epidural hematoma may vary depend on the site and size of the hematoma. In patients with cranial epidural hematoma various focal neurologic signs may be seen depend on the site of hematoma. Physical examination of patients with cranial epidural hematoma is usually remarkable for loss of consciousness, unilateral diminished deep tendon reflexes, unilateral fixed mydriasis and abnormal pupillary reflex, down and out positioned eyes, loss of vision in contralateral side of hematoma and abnormal vertical gaze, unilaterally muscle weakness and unilateral sensory loss.
Glasgow coma scale in most patients with epidural hematoma is reduced. In patients with brain herniation due to the epidural hematoma respiratory arrest and Cushing's triad(hypertension, bradycardia, and irregular respiration) may be seen. Findings in neck examination of patients with spinal epidural hematoma is usually include stiffness and tenderness.
Physical Examination
- Findings in physical examination of patients with epidural hematoma may vary depend on the site of hematoma.
- In patients with cranial epidural hematoma various focal neurologic signs may be seen depend on the site of hematoma.
- Physical examination of patients with cranial epidural hematoma is usually remarkable for loss of consciousness, unilateral diminished deep tendon reflexes, unilateral fixed mydriasis and abnormal pupillary reflex, down and out positioned eyes, loss of vision in contralateral side of hematoma and abnormal vertical gaze, unilaterally muscle weakness and unilateral sensory loss.[1][2]
- Glasgow coma scale in most patients with epidural hematoma is reduced.[3]
- In patients with brain herniation due to the epidural hematoma respiratory arrest and Cushing's triad(hypertension, bradycardia, and irregular respiration) may be seen.[4][5]
- Findings in neck examination of patients with spinal epidural hematoma is usually include stiffness and tenderness.[6]
Appearance of the Patient
Vital Signs
- Bradycardia with regular pulse may be seen.[4]
- Tachypnea and irregular respiration may be present.[4]
- High blood pressure with normal pulses pressure may be seen.[4]
Skin
- Pallor may be present.
HEENT
Findings in HEENT examination of patients with epidural hematoma may include:[1][8]
- Evidence of trauma
- Abnormal extra-ocular eye movements
- Non-reactive pupils to light and to accommodation
- Hearing acuity may be reduced
- Tenderness upon palpation of the scalp
- Facial tenderness
Neck
- Findings in neck examination of patients with spinal epidural hematoma is usually include:[6]
- Stiffness
- Tenderness
Heart
- Patients with epidural hematoma may have tachycardia or bradycardia.[9]
Abdomen
- Abdominal examination of patients with epidural hematoma is usually normal.
Back
- In patients with spinal epidural hematoma point tenderness over the vertebral column may be present.[10]
Genitourinary
- Genitourinary examination of patients with epidural hematoma is usually normal.
Neuromuscular
- Neuromuscular examination of patients with epidural hematoma may be remarkable for:[1][8][3][11][12][13][2]
- loss of orientation to persons, place, and time.
- Altered mental status
- Low glasgow coma scale
- Clonus
- Hyperreflexia
- Unilaterally positive (abnormal) Babinski reflex
- Muscle rigidity
- Unilaterally muscle weakness
- Abnormal extra-ocular movements
- Non-reactive pupils to light and to accommodation
- Unilateral sensory loss
- Abnormal gait
References
- ↑ 1.0 1.1 1.2 Rangwala SD, Birk DM, Tobin MK, Hahn YS, Nikas DC (2017). "Spontaneous Resolution of Spinal Epidural Hematoma Resulting from Domestic Child Abuse: Case Report". Pediatr Neurosurg. 52 (1): 51–54. doi:10.1159/000448737. PMID 27644085.
- ↑ 2.0 2.1 Aycan A, Ozdemir S, Arslan H, Gonullu E, Bozkına C (2016). "Idiopathic Thoracic Spontaneous Spinal Epidural Hematoma". Case Rep Surg. 2016: 5430708. doi:10.1155/2016/5430708. PMC 4819082. PMID 27088028.
- ↑ 3.0 3.1 Jeong YH, Oh JW, Cho S, Korean Trauma Data Bank System Committee (2016). "Clinical Outcome of Acute Epidural Hematoma in Korea: Preliminary Report of 285 Cases Registered in the Korean Trauma Data Bank System". Korean J Neurotrauma. 12 (2): 47–54. doi:10.13004/kjnt.2016.12.2.47. PMC 5110918. PMID 27857907.
- ↑ 4.0 4.1 4.2 4.3 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.
- ↑ Allen KA (2016). "Pathophysiology and Treatment of Severe Traumatic Brain Injuries in Children". J Neurosci Nurs. 48 (1): 15–27, quiz E1. doi:10.1097/JNN.0000000000000176. PMC 4698894. PMID 26720317.
- ↑ 6.0 6.1 Aristedis R, Dimitrios B (2017). "Spinal epidural hematoma mimicking subarachnoid hemorrhage: A case study". Surg Neurol Int. 8: 182. doi:10.4103/sni.sni_197_17. PMC 5569401. PMID 28868194.
- ↑ Scheibl A, Calderón EM, Borau MJ, Prieto RM, González PF, Galiana GG (2012). "Epidural hematoma". J Pediatr Surg. 47 (2): e19–21. doi:10.1016/j.jpedsurg.2011.10.078. PMID 22325415.
- ↑ 8.0 8.1 Diyora B, Kukreja S, Nayak N, Kamble H, Sharma A (2014). "Complete third nerve palsy: Only presenting sign of extradural hematoma in an awake patient". Oman J Ophthalmol. 7 (2): 103–4. doi:10.4103/0974-620X.137177. PMC 4134542. PMID 25136243.
- ↑ Stevens RD, Shoykhet M, Cadena R (2015). "Emergency Neurological Life Support: Intracranial Hypertension and Herniation". Neurocrit Care. 23 Suppl 2: S76–82. doi:10.1007/s12028-015-0168-z. PMC 4791176. PMID 26438459.
- ↑ Xian H, Xu LW, Li CH, Hao JM, Wan WX, Feng GD; et al. (2017). "Spontaneous spinal epidural hematomas: One case report and rehabilitation outcome". Medicine (Baltimore). 96 (44): e8473. doi:10.1097/MD.0000000000008473. PMC 5682821. PMID 29095302.
- ↑ Roy SP, Agrawal N (2012). "Brown Sequard Syndrome Secondary to a Spontaneous Cervical Epidural Hematoma - A Rare Entity". J Orthop Case Rep. 2 (4): 23–5. PMC 4722547. PMID 27298881.
- ↑ Futawatari K, Matsuoka S, Kowada M (1991). "[A case of spinal epidural hematoma associated with idiopathic thrombocytopenic purpura]". No Shinkei Geka. 19 (12): 1187–90. PMID 1766546.
- ↑ Kamoda H, Ishikawa T, Miyagi M, Eguchi Y, Orita S, Suzuki M; et al. (2013). "Delayed postoperative epidural hematoma presenting only with vesicorectal disturbance". Case Rep Orthop. 2013: 861961. doi:10.1155/2013/861961. PMC 3773434. PMID 24073350.