Epidural hematoma physical examination: Difference between revisions

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==Overview==
==Overview==
Findings in physical examination of patients with epidural hematoma may vary depend on the site and size of the [[hematoma]]. In patients with [[cranial]] epidural hematoma various [[focal neurologic signs]] may be seen depend on the site of [[hematoma]]. Physical examination of patients with [[cranial]] epidural hematoma is usually remarkable for [[loss of consciousness]], unilateral [[Deep tendon reflex|diminished deep tendon reflexes]], unilateral fixed [[mydriasis]] and abnormal [[pupillary reflex]], down and out positioned eyes, loss of vision in [[contralateral]] side of [[hematoma]] and abnormal [[Vertical gaze center|vertical gaze]], unilaterally muscle weakness and unilateral [[sensory loss]].
[[Glasgow coma scale]] in most patients with epidural hematoma is reduced. In patients with [[brain herniation]] due to the epidural hematoma [[respiratory arrest]] and [[Cushing's triad]](hypertension, [[bradycardia]], and irregular [[respiration]]) may be seen. Findings in neck examination of patients with spinal epidural hematoma is usually include [[stiffness]] and [[tenderness]].


==Physical Examination==
==Physical Examination==
*Findings in physical examination of patients with epidural hematoma may vary depend on the site of hematoma.
*Findings in physical examination of patients with epidural hematoma may vary depend on the site of [[hematoma]].
*In patients with cranial epidural hematoma various focal neurologic sign may be seen depend on the site of hematoma.
*In patients with [[cranial]] epidural hematoma various [[focal neurologic signs]] may be seen depend on the site of [[hematoma]].
*Physical examination of patients with cranial epidural hematoma is usually remarkable for loss of consciousness, unilateral diminished deep tendon reflexes,
*Physical examination of patients with [[cranial]] epidural hematoma is usually remarkable for [[loss of consciousness]], unilateral [[Deep tendon reflex|diminished deep tendon reflexes]], unilateral fixed [[mydriasis]] and abnormal [[pupillary reflex]], down and out positioned eyes, loss of vision in [[contralateral]] side of [[hematoma]] and abnormal [[Vertical gaze center|vertical gaze]], unilaterally muscle weakness and unilateral [[sensory loss]].<ref name="pmid27644085">{{cite journal| author=Rangwala SD, Birk DM, Tobin MK, Hahn YS, Nikas DC| title=Spontaneous Resolution of Spinal Epidural Hematoma Resulting from Domestic Child Abuse: Case Report. | journal=Pediatr Neurosurg | year= 2017 | volume= 52 | issue= 1 | pages= 51-54 | pmid=27644085 | doi=10.1159/000448737 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27644085  }} </ref><ref name="pmid27088028">{{cite journal| author=Aycan A, Ozdemir S, Arslan H, Gonullu E, Bozkına C| title=Idiopathic Thoracic Spontaneous Spinal Epidural Hematoma. | journal=Case Rep Surg | year= 2016 | volume= 2016 | issue=  | pages= 5430708 | pmid=27088028 | doi=10.1155/2016/5430708 | pmc=4819082 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27088028  }} </ref>
unilateral fixed mydriasis and abnormal pupillary reflex, down and out positioned eyes and loss of vision in contralateral side of hematoma and abnormal vertical gaze.
*[[Glasgow coma scale]] in most patients with epidural hematoma is reduced.<ref name="pmid27857907">{{cite journal| author=Jeong YH, Oh JW, Cho S, Korean Trauma Data Bank System Committee| title=Clinical Outcome of Acute Epidural Hematoma in Korea: Preliminary Report of 285 Cases Registered in the Korean Trauma Data Bank System. | journal=Korean J Neurotrauma | year= 2016 | volume= 12 | issue= 2 | pages= 47-54 | pmid=27857907 | doi=10.13004/kjnt.2016.12.2.47 | pmc=5110918 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27857907  }} </ref>
*In patients with brain herniation due to epidural hematoma respiratory arrest and Cushing's triad(hypertension, bradycardia, and irregular respiration) may be seen.
*In patients with [[brain herniation]] due to the epidural hematoma [[respiratory arrest]] and [[Cushing's triad]](hypertension, [[bradycardia]], and irregular [[respiration]]) may be seen.<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><ref name="pmid26720317">{{cite journal| author=Allen KA| title=Pathophysiology and Treatment of Severe Traumatic Brain Injuries in Children. | journal=J Neurosci Nurs | year= 2016 | volume= 48 | issue= 1 | pages= 15-27; quiz E1 | pmid=26720317 | doi=10.1097/JNN.0000000000000176 | pmc=4698894 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26720317  }} </ref>
*Findings in neck examination of patients with spinal epidural hematoma is usually include [[stiffness]] and [[tenderness]].<ref name="pmid28868194">{{cite journal| author=Aristedis R, Dimitrios B| title=Spinal epidural hematoma mimicking subarachnoid hemorrhage: A case study. | journal=Surg Neurol Int | year= 2017 | volume= 8 | issue=  | pages= 182 | pmid=28868194 | doi=10.4103/sni.sni_197_17 | pmc=5569401 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28868194  }} </ref>


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with epidural hematoma usually appear ill and confused and may have sever pain.  
*Patients with epidural hematoma usually appear ill and [[Confusion|confused]] and may have sever pain.<ref name="pmid22325415">{{cite journal| author=Scheibl A, Calderón EM, Borau MJ, Prieto RM, González PF, Galiana GG| title=Epidural hematoma. | journal=J Pediatr Surg | year= 2012 | volume= 47 | issue= 2 | pages= e19-21 | pmid=22325415 | doi=10.1016/j.jpedsurg.2011.10.078 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22325415  }} </ref>


===Vital Signs===
===Vital Signs===


*[[Bradycardia]] with regular pulse mat be seen.
*[[Bradycardia]] with regular pulse may be seen.<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>
*Tachypnea and irregular respiration may be present.
*[[Tachypnea]] and irregular [[respiration]] may be present.<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>
*High/low blood pressure with normal pulse pressure may be seen.
*High blood pressure with normal pulses pressure may be seen.<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>


===Skin===
===Skin===
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===HEENT===
===HEENT===
Findings in HEENT examination of patients with epidural hematoma may include:
Findings in HEENT examination of patients with epidural hematoma may include:<ref name="pmid27644085">{{cite journal| author=Rangwala SD, Birk DM, Tobin MK, Hahn YS, Nikas DC| title=Spontaneous Resolution of Spinal Epidural Hematoma Resulting from Domestic Child Abuse: Case Report. | journal=Pediatr Neurosurg | year= 2017 | volume= 52 | issue= 1 | pages= 51-54 | pmid=27644085 | doi=10.1159/000448737 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27644085  }} </ref><ref name="pmid25136243">{{cite journal| author=Diyora B, Kukreja S, Nayak N, Kamble H, Sharma A| title=Complete third nerve palsy: Only presenting sign of extradural hematoma in an awake patient. | journal=Oman J Ophthalmol | year= 2014 | volume= 7 | issue= 2 | pages= 103-4 | pmid=25136243 | doi=10.4103/0974-620X.137177 | pmc=4134542 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25136243  }} </ref>


* Evidence of trauma
* Evidence of [[trauma]]
* Icteric sclera
* Abnormal extra-[[ocular]] eye movements
* [[Nystagmus]]  
* Non-reactive [[pupils]] to light and to [[Accommodation (eye)|accommodation]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
* Tenderness upon palpation of the scalp
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
* Findings in neck examination of patients with spinal epidural hematoma is usually include:<ref name="pmid28868194">{{cite journal| author=Aristedis R, Dimitrios B| title=Spinal epidural hematoma mimicking subarachnoid hemorrhage: A case study. | journal=Surg Neurol Int | year= 2017 | volume= 8 | issue= | pages= 182 | pmid=28868194 | doi=10.4103/sni.sni_197_17 | pmc=5569401 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28868194  }} </ref>
OR
* [[Stiffness]]
*[[Jugular venous distension]]
* [[Tenderness]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
 
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* Patients with epidural hematoma may have [[tachycardia]] or [[bradycardia]].<ref name="pmid26438459">{{cite journal| author=Stevens RD, Shoykhet M, Cadena R| title=Emergency Neurological Life Support: Intracranial Hypertension and Herniation. | journal=Neurocrit Care | year= 2015 | volume= 23 Suppl 2 | issue=  | pages= S76-82 | pmid=26438459 | doi=10.1007/s12028-015-0168-z | pmc=4791176 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26438459  }} </ref>
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
 
===Abdomen===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
* Abdominal examination of patients with epidural hematoma is usually normal.
OR
*[[Abdominal distention]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
 
===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
*In patients with spinal epidural hematoma point tenderness over the [[vertebral column]] may be present.<ref name="pmid29095302">{{cite journal| author=Xian H, Xu LW, Li CH, Hao JM, Wan WX, Feng GD et al.| title=Spontaneous spinal epidural hematomas: One case report and rehabilitation outcome. | journal=Medicine (Baltimore) | year= 2017 | volume= 96 | issue= 44 | pages= e8473 | pmid=29095302 | doi=10.1097/MD.0000000000008473 | pmc=5682821 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29095302  }} </ref>
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
* [[Genitourinary]] examination of patients with epidural hematoma is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
 
===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
*[[Neuromuscular]] examination of patients with epidural hematoma may be remarkable for:<ref name="pmid27644085">{{cite journal| author=Rangwala SD, Birk DM, Tobin MK, Hahn YS, Nikas DC| title=Spontaneous Resolution of Spinal Epidural Hematoma Resulting from Domestic Child Abuse: Case Report. | journal=Pediatr Neurosurg | year= 2017 | volume= 52 | issue= 1 | pages= 51-54 | pmid=27644085 | doi=10.1159/000448737 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27644085  }} </ref><ref name="pmid25136243">{{cite journal| author=Diyora B, Kukreja S, Nayak N, Kamble H, Sharma A| title=Complete third nerve palsy: Only presenting sign of extradural hematoma in an awake patient. | journal=Oman J Ophthalmol | year= 2014 | volume= 7 | issue= 2 | pages= 103-4 | pmid=25136243 | doi=10.4103/0974-620X.137177 | pmc=4134542 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25136243  }} </ref><ref name="pmid27857907">{{cite journal| author=Jeong YH, Oh JW, Cho S, Korean Trauma Data Bank System Committee| title=Clinical Outcome of Acute Epidural Hematoma in Korea: Preliminary Report of 285 Cases Registered in the Korean Trauma Data Bank System. | journal=Korean J Neurotrauma | year= 2016 | volume= 12 | issue= 2 | pages= 47-54 | pmid=27857907 | doi=10.13004/kjnt.2016.12.2.47 | pmc=5110918 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27857907  }} </ref><ref name="pmid27298881">{{cite journal| author=Roy SP, Agrawal N| title=Brown Sequard Syndrome Secondary to a Spontaneous Cervical Epidural Hematoma - A Rare Entity. | journal=J Orthop Case Rep | year= 2012 | volume= 2 | issue= 4 | pages= 23-5 | pmid=27298881 | doi= | pmc=4722547 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27298881  }} </ref><ref name="pmid1766546">{{cite journal| author=Futawatari K, Matsuoka S, Kowada M| title=[A case of spinal epidural hematoma associated with idiopathic thrombocytopenic purpura]. | journal=No Shinkei Geka | year= 1991 | volume= 19 | issue= 12 | pages= 1187-90 | pmid=1766546 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1766546  }} </ref><ref name="pmid24073350">{{cite journal| author=Kamoda H, Ishikawa T, Miyagi M, Eguchi Y, Orita S, Suzuki M et al.| title=Delayed postoperative epidural hematoma presenting only with vesicorectal disturbance. | journal=Case Rep Orthop | year= 2013 | volume= 2013 | issue=  | pages= 861961 | pmid=24073350 | doi=10.1155/2013/861961 | pmc=3773434 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24073350  }} </ref><ref name="pmid27088028">{{cite journal| author=Aycan A, Ozdemir S, Arslan H, Gonullu E, Bozkına C| title=Idiopathic Thoracic Spontaneous Spinal Epidural Hematoma. | journal=Case Rep Surg | year= 2016 | volume= 2016 | issue=  | pages= 5430708 | pmid=27088028 | doi=10.1155/2016/5430708 | pmc=4819082 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27088028  }} </ref>
OR
**loss of orientation to persons, place, and time.
*Patient is usually oriented to persons, place, and time
** [[Altered mental status]]
* Altered mental status
** Low [[glasgow coma scale]]
* Glasgow coma scale is ___ / 15
** [[Clonus]]
* Clonus may be present
** [[Hyperreflexia]]
* Hyperreflexia / hyporeflexia / areflexia
** Unilaterally positive (abnormal) [[Babinski reflex]]
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
** Muscle rigidity
* Muscle rigidity
** Unilaterally muscle weakness
* Proximal/distal muscle weakness unilaterally/bilaterally
** Abnormal extra-[[ocular]] movements
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
**Non-reactive pupils to light and to [[Accommodation (eye)|accommodation]]
*Unilateral/bilateral upper/lower extremity weakness
**Unilateral [[sensory loss]]
*Unilateral/bilateral sensory loss in the upper/lower extremity
**[[Gait abnormality|Abnormal gait]]
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)
 
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
OR
*[[Clubbing]]  
*[[Cyanosis]]  
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Latest revision as of 16:07, 13 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

Findings in physical examination of patients with epidural hematoma may vary depend on the site and size of the hematoma. In patients with cranial epidural hematoma various focal neurologic signs may be seen depend on the site of hematoma. Physical examination of patients with cranial epidural hematoma is usually remarkable for loss of consciousness, unilateral diminished deep tendon reflexes, unilateral fixed mydriasis and abnormal pupillary reflex, down and out positioned eyes, loss of vision in contralateral side of hematoma and abnormal vertical gaze, unilaterally muscle weakness and unilateral sensory loss.

Glasgow coma scale in most patients with epidural hematoma is reduced. In patients with brain herniation due to the epidural hematoma respiratory arrest and Cushing's triad(hypertension, bradycardia, and irregular respiration) may be seen. Findings in neck examination of patients with spinal epidural hematoma is usually include stiffness and tenderness.

Physical Examination

Appearance of the Patient

  • Patients with epidural hematoma usually appear ill and confused and may have sever pain.[7]

Vital Signs

Skin

HEENT

Findings in HEENT examination of patients with epidural hematoma may include:[1][8]

  • Evidence of trauma
  • Abnormal extra-ocular eye movements
  • Non-reactive pupils to light and to accommodation
  • Hearing acuity may be reduced
  • Tenderness upon palpation of the scalp
  • Facial tenderness

Neck

  • Findings in neck examination of patients with spinal epidural hematoma is usually include:[6]
  • Stiffness
  • Tenderness

Heart

Abdomen

  • Abdominal examination of patients with epidural hematoma is usually normal.

Back

  • In patients with spinal epidural hematoma point tenderness over the vertebral column may be present.[10]

Genitourinary

  • Genitourinary examination of patients with epidural hematoma is usually normal.

Neuromuscular

References

  1. ↑ 1.0 1.1 1.2 Rangwala SD, Birk DM, Tobin MK, Hahn YS, Nikas DC (2017). "Spontaneous Resolution of Spinal Epidural Hematoma Resulting from Domestic Child Abuse: Case Report". Pediatr Neurosurg. 52 (1): 51–54. doi:10.1159/000448737. PMID 27644085.
  2. ↑ 2.0 2.1 Aycan A, Ozdemir S, Arslan H, Gonullu E, Bozkına C (2016). "Idiopathic Thoracic Spontaneous Spinal Epidural Hematoma". Case Rep Surg. 2016: 5430708. doi:10.1155/2016/5430708. PMC 4819082. PMID 27088028.
  3. ↑ 3.0 3.1 Jeong YH, Oh JW, Cho S, Korean Trauma Data Bank System Committee (2016). "Clinical Outcome of Acute Epidural Hematoma in Korea: Preliminary Report of 285 Cases Registered in the Korean Trauma Data Bank System". Korean J Neurotrauma. 12 (2): 47–54. doi:10.13004/kjnt.2016.12.2.47. PMC 5110918. PMID 27857907.
  4. ↑ 4.0 4.1 4.2 4.3 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.
  5. ↑ Allen KA (2016). "Pathophysiology and Treatment of Severe Traumatic Brain Injuries in Children". J Neurosci Nurs. 48 (1): 15–27, quiz E1. doi:10.1097/JNN.0000000000000176. PMC 4698894. PMID 26720317.
  6. ↑ 6.0 6.1 Aristedis R, Dimitrios B (2017). "Spinal epidural hematoma mimicking subarachnoid hemorrhage: A case study". Surg Neurol Int. 8: 182. doi:10.4103/sni.sni_197_17. PMC 5569401. PMID 28868194.
  7. ↑ Scheibl A, Calderón EM, Borau MJ, Prieto RM, González PF, Galiana GG (2012). "Epidural hematoma". J Pediatr Surg. 47 (2): e19–21. doi:10.1016/j.jpedsurg.2011.10.078. PMID 22325415.
  8. ↑ 8.0 8.1 Diyora B, Kukreja S, Nayak N, Kamble H, Sharma A (2014). "Complete third nerve palsy: Only presenting sign of extradural hematoma in an awake patient". Oman J Ophthalmol. 7 (2): 103–4. doi:10.4103/0974-620X.137177. PMC 4134542. PMID 25136243.
  9. ↑ Stevens RD, Shoykhet M, Cadena R (2015). "Emergency Neurological Life Support: Intracranial Hypertension and Herniation". Neurocrit Care. 23 Suppl 2: S76–82. doi:10.1007/s12028-015-0168-z. PMC 4791176. PMID 26438459.
  10. ↑ Xian H, Xu LW, Li CH, Hao JM, Wan WX, Feng GD; et al. (2017). "Spontaneous spinal epidural hematomas: One case report and rehabilitation outcome". Medicine (Baltimore). 96 (44): e8473. doi:10.1097/MD.0000000000008473. PMC 5682821. PMID 29095302.
  11. ↑ Roy SP, Agrawal N (2012). "Brown Sequard Syndrome Secondary to a Spontaneous Cervical Epidural Hematoma - A Rare Entity". J Orthop Case Rep. 2 (4): 23–5. PMC 4722547. PMID 27298881.
  12. ↑ Futawatari K, Matsuoka S, Kowada M (1991). "[A case of spinal epidural hematoma associated with idiopathic thrombocytopenic purpura]". No Shinkei Geka. 19 (12): 1187–90. PMID 1766546.
  13. ↑ Kamoda H, Ishikawa T, Miyagi M, Eguchi Y, Orita S, Suzuki M; et al. (2013). "Delayed postoperative epidural hematoma presenting only with vesicorectal disturbance". Case Rep Orthop. 2013: 861961. doi:10.1155/2013/861961. PMC 3773434. PMID 24073350.

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