Epidural Hematoma

                       CLINICAL RADIOLOGY

                       Epidural Hematoma

                                        Epidural or extra Dural hematoma is a type of traumatic brain injury (TBI) in which a buildup of blood occurs between the Dura mater and the skull. The Dura mater also covers the spine, so epidural bleeds may also occur in the spinal column. Often due to trauma, the condition is potentially deadly because the buildup of blood may increase pressure in the intracranial space and compress delicate brain tissue. The condition is present in one to three percent of head injuries. Between 15 and 20% of epidural hematomas are fatal. 
                          

                      The most common location of an EDH is over temporoparital convexity, as the thin temporal squamosa easily fractures and causes damage to the partially embedded middle meningial artery.

CT imaging for Epidural Hematoma

EDH in CT

>CT scanning is the study of choice in evaluating intracranial EDH, this modality is limited in the evaluation of spinal EDH because of the difficulty in examining long segments of the spine with axial CT images and because of the low attenuation of sub acute or chronic EDH
 >CT scan appearance of EDH depends on the source of bleeding; the time elapsed since injury, the severity of hemorrhage, and the degree of clot organization and breakdown.^[
 >Classically a biconvex (elliptical, idly shaped) hyper dense collection bounded by cranial sutures and associated with a skull fracture.
>may be heterogeneous or atypical if active bleeding is occurring.



MR imaging for Epidural Hematoma
                                                                                                                                     

SPINAL EDH in MRI

> MRI demonstrates a biconvex mass separated from the overlying Dura by a thin rim of extruded serum lying between the clot and the Dura. This stripe is hyper intense on both T1- and T2-weighted images.
 >Acute EDH is iso intense to minimally hypo intense on T1-weighted images and markedly hypo intense on T2-weighted images
>Sub acute EDH is hyper intense on T1-weighted images,. On T1-weighted images, the Dura may be seen as a thin, hypo intense stripe that the hematoma displaces inwardly.
 >In spinal EDH, MRI demonstrates a biconcave, elongated mass in the epidural space with variable degrees of cord compression separated from the spinal cord by low-intensity Dura. The signal intensity of spinal EDH varies with the age of the hemorrhage and parallels that of the brain.
                                                                                                                                             

Treatment 

                     
 As with other types  of  intracranil hematomas.the blood may be removed surgically to remove the mass and reduce the pressure it puts on the brain. The hematoma is evacuated through a  burr hole or craniotomy. If transfer to a facility with neurosurgery is prolonged trephination may be performed in the emergency department.

                                                                                                                                                     


.........................................................shabeerkodiyathur@gmail.com..................................................