Do you feel better after a head injury and then lose consciousness again? It could be an Epidural Hematoma (EDH)!

Did your child fall while playing? Maybe you slipped and fell off your bike and hit your head somewhere? Most of the time, we don't pay much attention to things like this, thinking, "Oh... it's just a little bump." But sometimes, even a minor head injury can lead to something serious that can affect your life. Today, we're talking about a condition that can happen at such a time, and can be very dangerous if not treated quickly. In medicine, we call this an Epidural Hematoma, or EDH for short.

Simply put, what is Epidural Hematoma (EDH)?

Think of our brain as something very precious and fragile. Our strong skull is there to protect it. But between the skull and the brain are three other protective layers. We call these the meninges. Of these three layers, the thickest layer, just beneath the skull, is called the dura mater.

Now, when you get a hard blow to the head, a blood vessel inside the skull, an artery or sometimes a vein, can rupture. When it ruptures, blood starts to leak out. This blood collects in the small space between the skull and the dura mater, the outer covering of the brain. This blood pooling is called an `Epidural Hematoma (EDH)`.

Simply put, it's like water leaking between the plaster layer and the wall and swelling like a bubble. As this blood clot gradually grows, it starts to push inward, that is, towards our brain. This pushing can cause brain damage. This is a very serious condition that requires emergency medical treatment.

This condition is also called `Extradural Hematoma`. Generally, this is also known as `Traumatic Brain Injury (TBI)`, a brain injury caused by a head injury.

How serious is this situation?

Yes, `Epidural Hematoma (EDH)` is a serious condition that can be life-threatening . If not treated immediately, it can cause permanent brain damage or even death. According to reports, about 15% of people who develop this condition die. Therefore, it is never a good idea to take a head injury lightly.

Who is most at risk?

Although this condition can occur in anyone who suffers a head injury, some people are at higher risk.

• Young people: This condition is especially common among young people.
• People with skull fractures: This risk is much higher in accidents involving skull fractures.
• Sportspeople: People who play sports, especially cycling, skateboarding, rugby, and cricket, are at higher risk of accidents.
• Car accidents: This condition can be caused by head injuries in car or motorcycle accidents, which are especially common in Sri Lanka.
• Men: Men are about four times more likely to develop EDH than women.

This condition rarely occurs in children under two years of age and people over 60 years of age.

What are the symptoms of this? How to recognize it?

The most dangerous and unique thing about this is the way the symptoms appear. In most cases, but not everyone, you can see this pattern:

1. Initial loss of consciousness: Immediately after a head injury, consciousness is lost for a few seconds or minutes.

2. Lucid Interval: Then, you regain consciousness, talk normally as if nothing is wrong, and feel fine for a few hours. We call this period the `Lucid Interval`. This is the most dangerous and misleading time . Because if you take the patient home thinking that he is fine, it can be a big problem.

3. Rapid deterioration: After a few hours, when the blood clot that has accumulated inside begins to press on the brain, the patient's condition suddenly worsens. They may lose consciousness again and even go into a coma.

In addition to this main pattern, these symptoms can appear within minutes to hours after the accident.

If the situation gets worse...

If the bleeding does not stop and is not treated, the pressure on the brain will increase and the symptoms will become worse.

• Seizures
• Difficulty breathing
• Loss of brain function
• Coma state
• Death at the end

What causes this?

The main cause is a head injury . About 75% of EDH cases are accompanied by a skull fracture. The most common cause is a fracture of the temporal bone, especially above the ear, causing damage to the middle meningeal artery, a blood vessel that runs through it.

But very rarely, this condition can occur for other reasons without any danger.

• Infection/abscess
• Blood clotting disorders (Coagulopathy)
• Hemorrhagic brain tumors
• Vascular malformations

How do doctors diagnose this?

When someone is brought to the hospital after a head injury, especially if they have the symptoms mentioned earlier, doctors will quickly run several tests.

• CT scan (Computed Tomography): This is the main and fastest method. It is like taking a three-dimensional (3D) X-ray picture of the inside of the head. This can clearly see where the blood clot is, its size, and how much pressure it is putting on the brain.
• MRI scan (Magnetic Resonance Imaging): This is also a test to look inside the brain. It is more detailed than a CT scan, but is usually the first scan done in an emergency.
• Blood tests: Sometimes blood tests are also done to see if there is a blood clotting problem.

How is it treated? Is surgery necessary?

An epidural hematoma is a medical emergency that usually requires immediate surgery . Without relief of the pressure on the brain, permanent brain damage or death can occur. The decision to require surgery is based on factors such as:

• The patient has a severe headache.
• Declining brain function (memory loss, confusion).
• A large blood clot (hematoma) was found on the CT scan.

Surgery

There are two main surgical methods.

1. Craniotomy and Hematoma Evacuation: This is the most common procedure. In this procedure, the surgeon temporarily removes a small portion of the skull and completely removes the blood clot inside. The bleeding vessel is identified and stopped, and the removed portion of the skull is reattached with a small pin.

2. Burr Holes: Another method is to drill one or more small holes in the skull and drain the blood through them. This method can quickly reduce pressure on the brain. Sometimes a tube is left in place for a few days after the surgery to remove any blood that continues to accumulate.

Conservative Treatment

Sometimes, if the blood clot is very small, it is not putting too much pressure on the brain, and the patient is not having severe symptoms, doctors may decide not to operate. In such cases, the patient is kept in the intensive care unit (ICU) and is closely monitored with regular CT scans to see if the blood clot is getting bigger. Our bodies can reabsorb small amounts of blood over time.

Other treatments

After surgery, medications such as ``mannitol, hypertonic saline`` are given to reduce swelling and pressure in the brain. Also, since there is a risk of seizures after head injuries, medications are sometimes prescribed to prevent them.

If there is any damage to the brain, rehabilitation treatments such as physical therapy, occupational therapy, and speech therapy may be necessary to help the patient recover.

What is the difference between Epidural and Subdural Hematoma?

You may have also heard of `Subdural Hematoma`. Although both are bleeding in the brain, there are clear differences between the two. This is also important to know.

What to do if someone who has hit their head has these symptoms?

This is the most important part. If you or someone you know has any of the following symptoms after hitting their head, take them to the nearest hospital Emergency Department (ETU) without delay.

• If you lose consciousness (even for a second)
• If you have a severe headache
• If the story gets tangled
• If you feel confused or sleepy
• If vomiting occurs
• If the black rings on both eyes are not the same (if one is larger)
• If you have dizziness or difficulty walking
• If one side of the body feels lifeless
• If a seizure occurs

Can't accidents like this be prevented?

We can't prevent accidents 100% of the time, but there are many things we can do to reduce the risk.

• Wear a helmet: When riding a motorcycle, bicycle, or playing sports such as rugby or cricket, be sure to wear a helmet of the correct standard.
• Wear a seat belt: Wear a seat belt whenever you are in a vehicle.
• Use safety equipment: Wear proper safety helmets if you are working at heights, in the construction industry, or in any job that could pose a risk to your head.
• Avoid diving in unknown places: Avoid diving in unknown rivers and streams, as there may be rocks or other obstacles.