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{{Epidural hematoma}}


{{Diagnostic study of choice}}
{{CMG}}; {{AE}}{{MMJ}}
{{CMG}}; {{AE}}{{MMJ}}




== Overview ==
== Overview ==
The CT scan is the gold standard test for the diagnosis of epidural hematoma. Among patients with head trauma CT scan is indicated for detecting epidural hematoma and other kind of [[Intracranial hemorrhage|intracranial hemorrhages]] in patients with: age > 60 years, [[Glasgow coma scale|glasgow Coma Scale]] under 15, [[Headache]], [[Vomiting]], [[Loss of consciousness]], [[Amnesia]], [[Alcohol intoxication|alcohol]] or [[drug intoxication]]. Screening for cervical spinal [[hematoma]] by [[CT scan]] is recommended among patients with acute onset of [[hemiparesis]], specially when they are associated with [[neck pain]].
The CT scan is the gold standard test for the diagnosis of epidural hematoma. The following findings on performing CT scan are confirmatory for epidural hematoma: Bi-convex (or [[lentiform]]) shaped [[hematoma]] in [[epidural space]] which '''can cross''' the [[Dura mater|dural]] reflections unlike a [[subdural hematoma]] but it '''does not cross''' [[skull]]'s suture lines where the [[Dura mater|dura]] tightly adheres to the adjacent [[skull]], depressed [[skull fracture]] in some cases of epidural hematoma, midline shift of brain tissue, subfalcine [[herniation]] and [[uncal herniation]]. Among patients with head trauma CT scan is indicated for detecting epidural hematoma and other kind of [[Intracranial hemorrhage|intracranial hemorrhages]] in patients with: age > 60 years, [[Glasgow coma scale|glasgow Coma Scale]] under 15, [[Headache]], [[Vomiting]], [[Loss of consciousness]], [[Amnesia]], [[Alcohol intoxication|alcohol]] or [[drug intoxication]]. Screening for cervical spinal [[hematoma]] by [[CT scan]] is recommended among patients with acute onset of [[hemiparesis]], specially when they are associated with [[neck pain]]. [[MRI scanner|MRI]] is the preferred imaging study for diagnosis of spinal epidural hematoma. In patients with spinal epidural hematoma findings on MRI suggestive of spinal epidural hematoma include: A variable signal intensity( Isointensity to cord in T1-weighted images and Hyperintensity with areas of hypointensity in T2-weighted images), capping of epidural fat, direct continuity with the adjacent [[osseous]] structures and compression of epidural fat, [[Subarachnoid cavity|subarachnoid sac]], and [[spinal cord]]. MRI is sensitive for diagnosis of intracranial epidural hematoma but it is rarely used for diagnosis of it because of its limited availability and because more time is needed to prepare the patients for MRI.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


=== Study of choice ===
=== Study of choice ===
The CT scan is the gold standard test for the diagnosis of epidural hematoma.
The [[Computed tomography|CT scan]] is the [[Gold standard (test)|gold standard]] test for the diagnosis of epidural hematoma.


===== Diagnostic results =====
===== Diagnostic results =====
The following finding(s) on performing CT scan are confirmatory for epidural hematoma:
The following findings on performing CT scan are confirmatory for epidural hematoma:
* Bi-convex (or lentiform) shaped hematoma in epidural space which '''can cross''' the dural reflections unlike a subdural hematoma but it '''does not cross''' skull's suture lines where the dura tightly adheres to the adjacent skull.
* Bi-convex (or [[lentiform]]) shaped [[hematoma]] in [[epidural space]] which '''can cross''' the [[Dura mater|dural]] reflections unlike a [[subdural hematoma]] but it '''does not cross''' [[skull]]'s suture lines where the [[Dura mater|dura]] tightly adheres to the adjacent [[skull]].<ref name="pmid21274684">{{cite journal| author=Kim JJ, Gean AD| title=Imaging for the diagnosis and management of traumatic brain injury. | journal=Neurotherapeutics | year= 2011 | volume= 8 | issue= 1 | pages= 39-53 | pmid=21274684 | doi=10.1007/s13311-010-0003-3 | pmc=3026928 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21274684  }} </ref><ref name="pmid18701165">{{cite journal| author=Huisman TA, Tschirch FT| title=Epidural hematoma in children: do cranial sutures act as a barrier? | journal=J Neuroradiol | year= 2009 | volume= 36 | issue= 2 | pages= 93-7 | pmid=18701165 | doi=10.1016/j.neurad.2008.06.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18701165  }} </ref>
* Depending on the size of hematoma, secondary features of mass effect may be present which include:
* Depressed [[skull fracture]] may be visualized in some cases of epidural hematoma in CT scan.<ref name="pmid18389258">{{cite journal| author=Vitali AM, Steinbok P| title=Depressed skull fracture and epidural hematoma from head fixation with pins for craniotomy in children. | journal=Childs Nerv Syst | year= 2008 | volume= 24 | issue= 8 | pages= 917-23; discussion 925 | pmid=18389258 | doi=10.1007/s00381-008-0621-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18389258  }} </ref>
** Midline shift
* Depending on the size of [[hematoma]], secondary features of mass effect may be present which include:
** Subfalcine herniation
** Midline shift<ref name="pmid23320175">{{cite journal| author=Chen H, Guo Y, Chen SW, Wang G, Cao HL, Chen J et al.| title=Progressive epidural hematoma in patients with head trauma: incidence, outcome, and risk factors. | journal=Emerg Med Int | year= 2012 | volume= 2012 | issue=  | pages= 134905 | pmid=23320175 | doi=10.1155/2012/134905 | pmc=3536037 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23320175  }} </ref>
** Uncal herniation
** Subfalcine [[herniation]]<ref name="pmid28966825">{{cite journal| author=Ben-Israel D, Isaacs AM, Morrish W, Gallagher NC| title=Acute vertex epidural hematoma. | journal=Surg Neurol Int | year= 2017 | volume= 8 | issue=  | pages= 219 | pmid=28966825 | doi=10.4103/sni.sni_218_17 | pmc=5609442 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28966825  }} </ref>
** [[Uncal herniation]]<ref name="pmid21274684">{{cite journal| author=Kim JJ, Gean AD| title=Imaging for the diagnosis and management of traumatic brain injury. | journal=Neurotherapeutics | year= 2011 | volume= 8 | issue= 1 | pages= 39-53 | pmid=21274684 | doi=10.1007/s13311-010-0003-3 | pmc=3026928 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21274684  }} </ref>


===== Sequence of Diagnostic Studies =====
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
Among patients with head trauma [[Computed tomography|CT scan]] is indicated for detecting epidural hematoma and other kind of [[Intracranial hemorrhage|intracranial hemorrhages]] in patients with:<ref name="pmid22090740">{{cite journal| author=Sharif-Alhoseini M, Khodadadi H, Chardoli M, Rahimi-Movaghar V| title=Indications for brain computed tomography scan after minor head injury. | journal=J Emerg Trauma Shock | year= 2011 | volume= 4 | issue= 4 | pages= 472-6 | pmid=22090740 | doi=10.4103/0974-2700.86631 | pmc=3214503 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22090740  }} </ref><ref name="pmid17652914">{{cite journal| author=Ono K, Wada K, Takahara T, Shirotani T| title=Indications for computed tomography in patients with mild head injury. | journal=Neurol Med Chir (Tokyo) | year= 2007 | volume= 47 | issue= 7 | pages= 291-7; discussion 297-8 | pmid=17652914 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17652914  }} </ref><ref name="pmid15897957">{{cite journal| author=Lee B, Newberg A| title=Neuroimaging in traumatic brain imaging. | journal=NeuroRx | year= 2005 | volume= 2 | issue= 2 | pages= 372-83 | pmid=15897957 | doi=10.1602/neurorx.2.2.372 | pmc=1064998 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15897957  }} </ref><ref name="pmid22515129">{{cite journal| author=Shima H, Yasuda M, Nomura M, Mori K, Miyashita K, Tamase A et al.| title=A spinal epidural hematoma with symptoms mimicking cerebral stroke. | journal=Nagoya J Med Sci | year= 2012 | volume= 74 | issue= 1-2 | pages= 207-10 | pmid=22515129 | doi= | pmc=4831268 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22515129  }} </ref>
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
*Age > 60 years
* A positive [test] is detected in the patient, to confirm the diagnosis.
*[[Glasgow coma scale|Glasgow Coma Scale]] under 15
*[[Headache]]
*[[Vomiting]]
*[[Loss of consciousness]]
*[[Amnesia]]
*[[Alcohol intoxication|Alcohol]] or [[drug intoxication]]


=== Diagnostic Criteria ===
*Screening for cervical spinal [[hematoma]] by [[CT scan]] is recommended among patients with acute onset of [[hemiparesis]], specially when they are associated with [[neck pain]].
* Here you should describe the details of the diagnostic criteria.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
** Criteria 1
** Criteria 2
** Criteria 3


IF there are clear, established diagnostic criteria:
=== Spinal epidural hematoma ===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* [[MRI scanner|MRI]] is the preferred imaging study for diagnosis of spinal epidural hematoma.<ref name="pmid10096331">{{cite journal| author=Sklar EM, Post JM, Falcone S| title=MRI of acute spinal epidural hematomas. | journal=J Comput Assist Tomogr | year= 1999 | volume= 23 | issue= 2 | pages= 238-43 | pmid=10096331 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10096331  }} </ref><ref name="pmid17353109">{{cite journal| author=Braun P, Kazmi K, Nogués-Meléndez P, Mas-Estellés F, Aparici-Robles F| title=MRI findings in spinal subdural and epidural hematomas. | journal=Eur J Radiol | year= 2007 | volume= 64 | issue= 1 | pages= 119-25 | pmid=17353109 | doi=10.1016/j.ejrad.2007.02.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17353109  }} </ref>
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria:  
*There are no established criteria for the diagnosis of [disease name].


===Indication of CT scan in diagnosis of epidural hematoma===
* In patients with spinal epidural hematoma findings on MRI suggestive of spinal epidural hematoma include:<ref name="pmid10096331" /><ref name="pmid17353109" />
* Among patients with head trauma CT scan is indicated for detecting epidural hematoma and other kind of [[Intracranial hemorrhage|intracranial hemorrhages]] in patients with:<ref name="pmid22090740">{{cite journal| author=Sharif-Alhoseini M, Khodadadi H, Chardoli M, Rahimi-Movaghar V| title=Indications for brain computed tomography scan after minor head injury. | journal=J Emerg Trauma Shock | year= 2011 | volume= 4 | issue= 4 | pages= 472-6 | pmid=22090740 | doi=10.4103/0974-2700.86631 | pmc=3214503 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22090740  }} </ref><ref name="pmid17652914">{{cite journal| author=Ono K, Wada K, Takahara T, Shirotani T| title=Indications for computed tomography in patients with mild head injury. | journal=Neurol Med Chir (Tokyo) | year= 2007 | volume= 47 | issue= 7 | pages= 291-7; discussion 297-8 | pmid=17652914 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17652914  }} </ref><ref name="pmid15897957">{{cite journal| author=Lee B, Newberg A| title=Neuroimaging in traumatic brain imaging. | journal=NeuroRx | year= 2005 | volume= 2 | issue= 2 | pages= 372-83 | pmid=15897957 | doi=10.1602/neurorx.2.2.372 | pmc=1064998 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15897957  }} </ref><ref name="pmid22515129">{{cite journal| author=Shima H, Yasuda M, Nomura M, Mori K, Miyashita K, Tamase A et al.| title=A spinal epidural hematoma with symptoms mimicking cerebral stroke. | journal=Nagoya J Med Sci | year= 2012 | volume= 74 | issue= 1-2 | pages= 207-10 | pmid=22515129 | doi= | pmc=4831268 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22515129  }} </ref>
** A variable signal intensity:
**Age > 60 years
*** Isointensity to cord in T1-weighted images
**[[Glasgow coma scale|Glasgow Coma Scale]] under 15
*** Hyperintensity with areas of hypointensity in T2-weighted images
**[[Headache]]
** Capping of epidural fat
**[[Vomiting]]
** Direct continuity with the adjacent [[osseous]] structures
**[[Loss of consciousness]]
** Compression of epidural fat, [[Subarachnoid cavity|subarachnoid sac]], and [[spinal cord]]
**[[Amnesia]]
==References==
**[[Alcohol intoxication|Alcohol]] or [[drug intoxication]]
{{Reflist|2}}
*Screening for cervical spinal [[hematoma]] by [[CT scan]] is recommended among patients with acute onset of [[hemiparesis]], specially when they are associated with [[neck pain]].
{{WH}}
<references />
{{WS}}

Latest revision as of 14:37, 14 June 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]


Overview

The CT scan is the gold standard test for the diagnosis of epidural hematoma. The following findings on performing CT scan are confirmatory for epidural hematoma: Bi-convex (or lentiform) shaped hematoma in epidural space which can cross the dural reflections unlike a subdural hematoma but it does not cross skull's suture lines where the dura tightly adheres to the adjacent skull, depressed skull fracture in some cases of epidural hematoma, midline shift of brain tissue, subfalcine herniation and uncal herniation. Among patients with head trauma CT scan is indicated for detecting epidural hematoma and other kind of intracranial hemorrhages in patients with: age > 60 years, glasgow Coma Scale under 15, Headache, Vomiting, Loss of consciousness, Amnesia, alcohol or drug intoxication. Screening for cervical spinal hematoma by CT scan is recommended among patients with acute onset of hemiparesis, specially when they are associated with neck pain. MRI is the preferred imaging study for diagnosis of spinal epidural hematoma. In patients with spinal epidural hematoma findings on MRI suggestive of spinal epidural hematoma include: A variable signal intensity( Isointensity to cord in T1-weighted images and Hyperintensity with areas of hypointensity in T2-weighted images), capping of epidural fat, direct continuity with the adjacent osseous structures and compression of epidural fat, subarachnoid sac, and spinal cord. MRI is sensitive for diagnosis of intracranial epidural hematoma but it is rarely used for diagnosis of it because of its limited availability and because more time is needed to prepare the patients for MRI.

Diagnostic Study of Choice

Study of choice

The CT scan is the gold standard test for the diagnosis of epidural hematoma.

Diagnostic results

The following findings on performing CT scan are confirmatory for epidural hematoma:

Sequence of Diagnostic Studies

Among patients with head trauma CT scan is indicated for detecting epidural hematoma and other kind of intracranial hemorrhages in patients with:[6][7][8][9]

Spinal epidural hematoma

  • MRI is the preferred imaging study for diagnosis of spinal epidural hematoma.[10][11]
  • In patients with spinal epidural hematoma findings on MRI suggestive of spinal epidural hematoma include:[10][11]
    • A variable signal intensity:
      • Isointensity to cord in T1-weighted images
      • Hyperintensity with areas of hypointensity in T2-weighted images
    • Capping of epidural fat
    • Direct continuity with the adjacent osseous structures
    • Compression of epidural fat, subarachnoid sac, and spinal cord

References

  1. ↑ 1.0 1.1 Kim JJ, Gean AD (2011). "Imaging for the diagnosis and management of traumatic brain injury". Neurotherapeutics. 8 (1): 39–53. doi:10.1007/s13311-010-0003-3. PMC 3026928. PMID 21274684.
  2. ↑ Huisman TA, Tschirch FT (2009). "Epidural hematoma in children: do cranial sutures act as a barrier?". J Neuroradiol. 36 (2): 93–7. doi:10.1016/j.neurad.2008.06.003. PMID 18701165.
  3. ↑ Vitali AM, Steinbok P (2008). "Depressed skull fracture and epidural hematoma from head fixation with pins for craniotomy in children". Childs Nerv Syst. 24 (8): 917–23, discussion 925. doi:10.1007/s00381-008-0621-9. PMID 18389258.
  4. ↑ Chen H, Guo Y, Chen SW, Wang G, Cao HL, Chen J; et al. (2012). "Progressive epidural hematoma in patients with head trauma: incidence, outcome, and risk factors". Emerg Med Int. 2012: 134905. doi:10.1155/2012/134905. PMC 3536037. PMID 23320175.
  5. ↑ Ben-Israel D, Isaacs AM, Morrish W, Gallagher NC (2017). "Acute vertex epidural hematoma". Surg Neurol Int. 8: 219. doi:10.4103/sni.sni_218_17. PMC 5609442. PMID 28966825.
  6. ↑ Sharif-Alhoseini M, Khodadadi H, Chardoli M, Rahimi-Movaghar V (2011). "Indications for brain computed tomography scan after minor head injury". J Emerg Trauma Shock. 4 (4): 472–6. doi:10.4103/0974-2700.86631. PMC 3214503. PMID 22090740.
  7. ↑ Ono K, Wada K, Takahara T, Shirotani T (2007). "Indications for computed tomography in patients with mild head injury". Neurol Med Chir (Tokyo). 47 (7): 291–7, discussion 297-8. PMID 17652914.
  8. ↑ Lee B, Newberg A (2005). "Neuroimaging in traumatic brain imaging". NeuroRx. 2 (2): 372–83. doi:10.1602/neurorx.2.2.372. PMC 1064998. PMID 15897957.
  9. ↑ Shima H, Yasuda M, Nomura M, Mori K, Miyashita K, Tamase A; et al. (2012). "A spinal epidural hematoma with symptoms mimicking cerebral stroke". Nagoya J Med Sci. 74 (1–2): 207–10. PMC 4831268. PMID 22515129.
  10. ↑ 10.0 10.1 Sklar EM, Post JM, Falcone S (1999). "MRI of acute spinal epidural hematomas". J Comput Assist Tomogr. 23 (2): 238–43. PMID 10096331.
  11. ↑ 11.0 11.1 Braun P, Kazmi K, Nogués-Meléndez P, Mas-Estellés F, Aparici-Robles F (2007). "MRI findings in spinal subdural and epidural hematomas". Eur J Radiol. 64 (1): 119–25. doi:10.1016/j.ejrad.2007.02.014. PMID 17353109.

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