An epidural hematoma is a serious head injury that tears a blood vessel just under your skull, on top of the brain's outer membrane, called the "dura." It often happens when you fracture your skull and the bleeding can form a blood clot.
The pool of blood forming the clot is called a hematoma which can be any size and location. If the clot grows larger, prompt emergency medical care can help prevent life-threatening complications.
Learn about the causes for epidural hematoma, how to know the symptoms, and when to get emergency treatment so you can heal and recover.
What Causes an Epidural Hematoma?
Most epidural hematomas are caused by a sudden (acute) head injury. "Acute" usually means the blood collects under your skull within a few hours after your injury.
Some common causes of head injury that can cause an epidural hematoma include:
- Car crash
- Fall
- Sports injury
Your head injury can tear an artery or vein. But often, the main blood vessel supplying nutrients to the dura tears – it’s called the middle meningeal artery. The tear allows blood to seep into the epidural space, between the skull and dura.
In rare cases, epidural hematomas can happen without injury and be caused by:
- Infection or abscess
- Bleeding disorders
- Blood vessel problems with your dura
- Some inherited disorders
- Tumors spreading to your brain
- Brain surgery complication
Bleeding near the spine can cause a spinal epidural hematoma. Your blood clot can press on your spinal cord, causing nerve damage and possible paralysis (not being able to move).
Epidural vs. Subdural Hematoma: What's the Difference?
"Epidural" and "subdural" tell you the location of the blood clot in your brain:
- Subdural hematomas happen just under the tough outer dura membrane that protects your brain. This blood clot can slowly bleed (chronic) to grow larger over weeks or months.
- Epidural hematomas clot just under your skull, but on top of the dura. This type of blood clot isn't as common.
What Are the Symptoms of an Epidural Hematoma?
Your symptoms depend on where your blood clot presses on your brain. Many people remain awake after an epidural hematoma, but some become drowsy or pass out. Other times, the clot can grow large enough to cause symptoms within minutes or hours after your injury.
You get symptoms because the clot can squeeze and press on nerves and brain tissue, and you may notice:
- Headache
- Vomiting
- Numbness
- Problems walking
- Slurred speech or not being able to talk
- Confusion or being less alert
- Dizziness
- Sleepiness
- Weakness or an enlarged pupil in one eye
- Seizures
You might also have a period where you pass out, then become alert – called a "lucid interval" – before passing out again.
"This can happen to about 5 to 10 out of 100 patients," says Reza J. Karimi, MD, FAANS, FACS, a neurosurgeon and vascular surgery specialist at New Jersey Brain and Spine. "But it's also a critical reason you should get immediate treatment for a head injury."
Are Epidural Hematomas Serious?
Yes, all head injuries are serious. After a head injury, get medical care right away. Your doctor can tell you if a blood vessel has torn which can prevent life-threatening complications from an epidural hematoma.
Epidural hematoma blood clots can "grow fast during the first few hours," says Karimi. "And in up to 10 out of 100 cases, the clot can cause serious brain compression (herniation) and ultimately be fatal if not treated in time."
What is a chronic epidural hematoma?
Sometimes, your blood clot slowly grows larger to press on your brain and cause symptoms — it’s called a chronic epidural hematoma.
"When this occurs, it's a surgical emergency, as the blood clot expands to cause more and more pressure on the brain," Karimi says. "The blood clot needs to be removed as soon as possible before a serious brain injury occurs."
When to Get Emergency Help After a Head Injury
Getting emergency medical care after your head injury is best if you notice any symptoms or changes. Your doctor can quickly make the right diagnosis and treat any bleeding.
Get medical care right away or call 911 if you injure your head and you have:
- Loss of consciousness for more than a few seconds
- Vomiting
- Problems balancing
- Trouble breathing
- Confusion, not being able to remember your injury, or agitation getting worse
- Serious head, nose, or ear bleeding
- Weakness or not being able to use your arm or leg
- One pupil gets bigger than the other
- Slurred speech
- Seizure
How Is an Epidural Hematoma Diagnosed?
To diagnose an epidural hematoma, your doctor may:
- Perform a neurological exam to check your brain, nerve, and muscle health.
- Order blood tests to check blood clotting time and rule out other health problems.
- Do imaging scans to find out if you have a subdural or epidural hematoma, its location, and size.
Head CT scan
A computed tomography scan can quickly show a detailed image of your blood clot, and it measures the size, too. A head CT scan helps your doctor decide if you need surgery.
Brain MRI scan
Magnetic resonance imaging scans are more sensitive, and their detailed images help your doctor see smaller or deeper blood clots and any nearby damage.
Cerebral CT angiography
Rarely, your doctor may need to see small blood vessel changes around your hematoma using angiography.
How Do You Treat an Epidural Hematoma?
Your doctor can use imaging scans, medications, and surgery when treating your epidural hematoma.
Can an Epidural Hematoma Heal Itself?
Small epidural hematomas that don’t cause symptoms can go away without treatment, but they still require monitoring. That’s because your blood clot typically grows within the first six hours after injury.
Your doctor will likely monitor your bleeding in the hospital for 24 hours using CT scans. If there's no growth or symptoms, a short hospital stay may be all you need.
"Most epidural hematomas are small, less than 1 centimeter, and will resorb on their own within several weeks," says Karimi. "Most clots are smaller-sized and don't really grow or require surgery. This is the most common scenario we see at a busy trauma center."
Medications
If you take blood thinners, your doctor may suggest short-term changes.
They may also give you medicine to help lower inflammation and brain swelling such as:
- Mannitol
- Hypertonic saline
- Glycerol
- Antiseizure medicine
Craniotomy
With a craniotomy (usually an open surgery), your doctor removes part of your skull bone to quickly take out the blood clot and release pressure on your brain. They'll also repair any blood vessels before replacing your skull bone.
A bigger blot clot that causes symptoms is "a surgical emergency, because it expands to cause more and more pressure on the brain,” Karimi says. “The blood clot needs to be removed as soon as possible before a serious brain injury occurs.”
Open surgery
In most cases, an open craniotomy takes less than an hour and can prevent serious brain damage, coma, and death.
"The standard treatment for significant epidural hematomas remains open surgery," says Harlan Bruner, MD, a board certified, fellowship-trained neurosurgeon at Advanced Neurosurgery Associates, an affiliate of Northside Hospital in Atlanta. "This is because your doctor needs to take pressure off the brain directly and evaluate any source of bleeding."
Burr hole evacuation
Your surgeon can quickly take pressure off your brain during burr hole evacuation. They'll carefully drill a small hole into your skull to drain extra fluid, such as blood. It commonly treats subdural hematomas, but also helps epidural hematomas.
Laminectomy
With a spinal epidural hematoma, your doctor can release pressure on your spinal nerves using a laminectomy. This surgery removes the back bony arch of your vertebrae in your spine. Once the small section of bone is gone, your spinal cord and nerves are free again and the tingling, numbness, and pain ease.
What are the potential complications of surgery for an epidural hematoma?
The surgery to correct your epidural hematoma is "a fast and simple operation in neurosurgery," Karimi says. Complications can depend on the type of surgery, blood clot size, and location.
The most common complications are infection and the blood clot coming back. "Both of these complications are rare, less than 3 out of 100 surgeries," says Karimi.
Some other brain surgery complications can include:
- Infection
- Brain herniation (pushes your brain out of its normal position)
- Bleeding
- Seizure
- Brain or spinal cord damage
- Coma
- Death
"While very serious or technical, the risks are quite uncommon, with most patients recovering well after surgery," Bruner says.
Can You Fully Recover From an Epidural Hematoma?
You have a better chance to fully recover fully if you:
- Get prompt treatment
- Have a small blood clot
- Don’t have symptoms
- Your pupils reacted normally
- You didn’t pass out
But full recovery can also depend on factors like your:
- Age
- Medical conditions
- Brain injury history
- How quickly your injury was treated
- Consciousness, if you pass out or slip into a coma
- Pupils, if they stay the same size or not
“In the vast majority of cases, even serious ones requiring emergency surgery, the recovery was almost always rapid with patients back to normal within a day or two,” Karimi says. Keep in mind that everyone heals differently and it can take months to recover.
Can an epidural hematoma cause a midline shift?
A large epidural hematoma can push your brain to one side of your skull, across the falx. It's called a midline shift. The falx line is where the dura membrane separates the right and left sides of your brain.
Can an epidural hematoma cause paralysis?
It’s uncommon, but a blood clot that presses on your spinal cord and nerves can cause damage – a spinal epidural hematoma. The nerve damage may cause permanent paralysis in your arm or leg, depending on the clot location.
What’s the survival rate after an epidural hematoma?
With quick treatment, more than 85 out of 100 people with epidural hematomas survive.
Takeaways
An epidural hematoma is a life-threatening head injury that tears a blood vessel to form a blood clot just below your skull on top of the dura, the outer protective cover of your brain. Epidural hematomas often cause skull fractures that need medical care right away. If you’ve had a head injury, get medical care right away to prevent life-threatening complications from epidural hematomas.
Epidural Hematoma FAQs
Are epidural hematomas painful?
Yes. Many epidural hematomas come with skull fractures, which can cause headaches, vomiting, and numbness.
What does a brain bleed headache feel like?
An epidural hematoma can put pressure on your brain. It can have symptoms like:
- Serious pain in your head (headache)
- Nausea and vomiting
- Weakness or not being able to move your arm or leg
- Dizziness
- Slurred speech
- You can't think straight and you get confused
- You're sleepy or tired, or you pass out or even have seizure
Is an epidural hematoma a stroke?
No, they're different conditions. A stroke can cause harm from a blocked or bleeding blood vessel inside your brain tissue. But an epidural hematoma tears a blood vessel outside of your brain to form a blood clot between your skull and the dura (outer brain cover).
