An extradural hemorrhage is bleeding that occurs between the brain and a layer of tissue that covers it, known as the dura mater. Sometimes an extradural hemorrhage is known as an epidural hematoma. The most common cause of the hemorrhage is a head injury where the skull is broken. This type of internal skull bleeding requires urgent treatment because it can lead to brain damage or death. The outlook is usually positive if surgery is carried out promptly to remove the accumulated blood.
Extradural hemorrhage symptoms most often develop following a blow to the head. Headache, drowsiness, dizziness and confusion may be accompanied by nausea and vomiting. Sometimes one pupil may appear enlarged. In up to around half of cases, loss of consciousness is followed by an alert phase, before the person slips into unconsciousness again. This sequence occurs because the person comes round following the initial blow to the head, but meanwhile the hemorrhage is growing inside the skull, until it becomes large enough to increase skull pressure and cause loss of consciousness once more.
Diagnosis of extradural hemorrhage can be made partly by examining the patient for signs such as unequal pupil sizes or weakness of a limb. These signs can indicate raised pressure inside the skull and damage to parts of the brain. A type of X-ray technique known as a CT, or computerized tomography, scan may be used to view the exact location of the hemorrhage, and standard X-rays may be used to provide images of any injuries associated with the bleeding.
Extradural hemorrhage treatment depends on the amount of bleeding that has occurred. A small hemorrhage may only require monitoring while the body absorbs the blood. Larger extradural hemorrhages may be treated surgically by drilling a hole in the skull, which lowers the pressure inside by allowing blood to leave. A large blood clot or accumulation of blood may require the creation of a bigger opening in the skull, through which it can be removed.
An extradural hemorrhage carries a risk of serious complications, including death, and it is important to treat the condition straight away to give the best chance of a good outcome. The outlook for an extradural hemorrhage is more likely to be positive if the person is conscious before surgery is carried out. For those people who remain unconscious, surgery is less likely to be successful. In some cases, damage to the brain leads to permanent problems such as seizures, weakness on one side of the body and speech difficulties.