Epidural Hematoma
An epidural (extradural) hematoma is a collection of blood between the inner surface of the skull and the brain's outer membrane (dura mater). It most often results from injury to the middle meningeal artery associated with a temporal bone fracture, can expand rapidly, and generally has a good outcome with early surgical evacuation. It is a neurosurgical emergency requiring prompt diagnosis.
最后更新: 2026-06-07
Definition
An epidural hematoma is an accumulation of blood in the potential space between the inner table of the skull and the dura mater. It accounts for roughly 5-15% of all traumatic intracranial hematomas. It most commonly lies in the temporoparietal region and usually arises from injury to the middle meningeal artery along a fracture line, although a proportion are venous in origin (tears of a dural venous sinus or diploic vein). It is more frequent in young adults and children, because in older age the dura is more firmly adherent to the skull.
Causes and Mechanism
An epidural hematoma almost always follows head trauma; the most common causes are road traffic accidents, falls and sports injuries. A temporal bone fracture accompanies the great majority of cases, although in children it can occur without a fracture because of the flexible skull. Arterial bleeding accumulates rapidly under pressure and produces a mass effect within a short time, whereas venous hematomas may progress more slowly.
Symptoms
The classically described pattern is the 'lucid interval': a brief loss of consciousness at the time of injury, followed by a period in which the patient is awake and alert, and then deterioration of consciousness as the hematoma enlarges. However, this classic course is seen only in a minority of patients. Common features include headache, nausea and vomiting, progressive impairment of consciousness, weakness on one side of the body (hemiparesis) and dilation of the pupil on the side of the hematoma (anisocoria). Bradycardia, raised blood pressure and irregular breathing (the Cushing response) are late and serious signs.
Diagnosis
An urgent non-contrast brain computed tomography (CT) scan is the gold standard for diagnosis. An epidural hematoma typically appears as a biconvex (lens-shaped) hyperdense mass and, because the dura is firmly attached to the skull at the suture lines, it usually does not cross these lines. This feature distinguishes it from a subdural hematoma, which is crescent-shaped and can cross suture lines. A fracture line is frequently seen on the bone window. The hematoma volume and any midline shift are assessed to guide the surgical decision. Posterior fossa hematomas warrant particular attention because of their proximity to the brainstem.
Treatment Options
An epidural hematoma is a neurosurgical emergency, and early diagnosis and treatment markedly improve outcomes. Hematomas that cause significant mass effect, have a large volume, produce midline shift or are associated with neurological deterioration are evacuated by urgent craniotomy; the source of bleeding is controlled and the dura is re-secured to the skull. In small, asymptomatic patients with a stable neurological status, close observation with follow-up CT may be appropriate, proceeding to surgery if there is clinical deterioration or hematoma enlargement. Posterior fossa hematomas are assessed more selectively. Treatment is planned individually for each patient.
Course and Recovery
Because the brain tissue is often not directly damaged in an epidural hematoma, recovery after early, timely surgery is generally good. Treating conscious patients early markedly improves outcomes, whereas the risk rises in patients who develop deep coma and bilateral pupil dilation. Follow-up imaging is performed after surgery, and rehabilitation may be needed if there is accompanying brain injury. Outcomes vary from patient to patient and no result can be guaranteed.
参考文献
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1072-1076.
- Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of acute epidural hematomas. Neurosurgery. 2006;58(3 Suppl):S7-S15.
- Carney N, Totten AM, O'Reilly C, et al. Guidelines for the Management of Severe Traumatic Brain Injury. 4th ed. Neurosurgery. 2017;80(1):6-15.
本文仅供一般参考，不能替代医疗检查。诊断与治疗决策因人而异。