Spontaneous spinal epidural hematoma sseh is a rare disease entity. Surgical management of acute epidural hematomas request pdf. Images in clinical medicine from the new england journal of medicine traumatic epidural hematoma. Intracranial epidural hematoma occurs in approximately 2% of patients with head injuries and 515% of patients with fatal head injuries. If left untreated, a person can face serious consequences, including death. Anesthetic management of spontaneous cervical epidural. Spinal epidural hematoma and epidural analgesia article pdf available in canadian journal of anaesthesia 504. Surgical management of spontaneous spinal epidural hematoma.
Chronic subdural hematoma csdh is one of the most common neurosurgical diagnoses in adults. Extradural hematomas edh are considered life threatening in that the risk for brain herniation is significant. It, therefore, requires urgent surgical evacuation to. Currently, epidural analgesia is an alternative to traditional pain medication administration in a vast array of clinical settings. Since bleeding is under artertial pressure, the hematoma may expand rapidly.
The morbidity and mortality result from mass effect on the brain as the hematoma. Spontaneous spinal epidural hematoma during pregnancy is a quite rare event requiring emergent decompressive surgery in the majority of cases to prevent permanent neurological damage. The disease is fundamentally a disorder of the meningeal blood vessels, and options exist for the minimally invasive neuroendovascular management. Mortality is largely due to increased intracranial pressure and herniation. Despite the risks of a serious and untreated edh, it has become increasingly apparent that many small epidural hematomas resolve with nonsurgical management without neurologic sequelae. Acute epidural hematoma edh in children is relatively uncommon, accounting for 23% of all tbi cases in this population. Epidural hematoma ie, accumulation of blood in the potential space between dura and bone may be intracranial edh or spinal sedh see. Epidural hematoma epidural hematoma clinical presentation. A hematoma occurs when blood leaks from a large blood vessel. An epidural hematoma edh greater than 30 cm3 should be surgically evacuated regardless of the patients glasgow coma scale gcs score.
Information about epidural hematoma edh general information. An epidural hematoma edh greater than 30 cm3 should be surgically evacuated regardless of the patients. Guidelines for the surgical management of tbi the brain trauma. Nonoperative management of acute epidural hematoma diagnosed. Although emergency surgical intervention was the classical.
Spontaneous spinal epidural hematoma develops only rarely, but it can leave serious sequelae when it does occur. Epidural catheterrelated problems, which are rare but serious, include insertion site infection, epidural abscess, epidural hematoma, and postdural puncture headache syndrome. Pain management today has earned recognition as a significant contributor to quality clinical outcomes. The management of a patient with a subdural hematoma will depend greatly on the extent of the bleed, its location, and the overall clinical status. Although several recent reports have described successful conservative management of epidural hematoma, surgical evacuation constitutes definitive treatment of this condition. An epidural hematoma edh greater than 30 cm3 should be. Acute spontaneous spinal epidural hematoma bleeding and. Patients with epidural hematomas who meet surgical criteria and receive prompt surgical intervention can have.
Aggressive or conservative management in extradural hematomas. An epidural hematoma edh occurs when blood accumulates between the skull and the dura mater, the thick membrane covering the brain. Twelve of these cases resulted from spinal surgery, seven from epidural catheters, four from vascular lesions, three from anticoagulation medications, two from trauma, and two from spontaneous causes. The potential for difficult airway management with the patient under general. Pdf spinal epidural hematoma and epidural analgesia. Head injury definition a history of a blow to the head or the presence of a scalp wound or those with evidence of altered consciousness after a relevant injury. Considerably less agreement exists among neurosurgeons re garding the treatment of asymptomatic or mildly symptomatic epidural hematomas edh.
Some reports have asserted that the cause is hypertension or coagulopathy 1, 6, 16, 25. Management and outcome of traumatic epidural hematoma in. Definisi epidural hematoma adalah hematoma antara tengkorak dan duramater. Thirty patients were treated surgically for spinal epidural hematoma seh. Therefore, there is little data in the literature regarding anesthetic management of cervical localization during pregnancy. An epidural hematoma edh greater than 30 cm 3 should be surgically evacuated regardless of the patients glasgow coma scale gcs score an edh less than 30 cm 3 and with less than a 15mm thickness and with less than a 5mm midline shift mls in patients with a gcs score greater than 8 without focal deficit can be managed nonoperatively with serial computed tomographic. Can occur in the spine epidural hematoma tears in small arteries predominantly the middle meningeal artery.
Most cases of acute spontaneous spinal epidural hematoma occur in older patients and are likely caused by the rupture of an epidural venous plexus. Some series 1822 and a few single case reports 2330 described good outcome with conservative management of selective epidural hematoma table 1. In this article, learn about the causes and symptoms of hematomas as well as the different types and when to see a doctor. Extradural hematoma edh accounts for 2% of all head injuries. An edh less than 30 cm3 andwith less than a 15mm thickness with less than a 5mm midline shift mls in patients with a gcs score greater than 8 without focal. We investigated 14 patients 11 men and 3 women who underwent hematoma removal for sseh from april 1998 to. Due to the atypical occurrence, pediatric edh poses a significant challenge for diagnosis and is not directly comparable to adult edh.
Epidural analgesia selfstudy baptist health south florida. Javedconservative management of significant supratentorial epidural hematomas in pediatric patients childs nerv syst, 30 2014, pp. In selected patients conservative management may be a feasible option. Epidural hematoma uncommon surgical management of posttraumatic epidural hematoma. Patients with epidural hematomas who meet surgical criteria and receive prompt surgical intervention can have an excellent prognosis. Started in 1995, this collection now contains 6769 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Epidural hematoma is an emergent neurosurgical disease that can be managed with close clinical and radiographic observation or surgical evacuation. Most cases involve skull fractures over the lateral convexities of the hemispheres, with rupture of middle meningeal artery branches.
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