Epidural vs Subdural Hematoma Image (2023)

FAQs

How can you tell the difference between an epidural and a subdural hematoma? ›

There are several differences, including: Location: An epidural hematoma (EDH) occurs between your skull and the outermost layer of meninges, the dura mater. A subdural hematoma occurs in the space between the dura mater and the second meninges layer, the arachnoid layer.

Magnetic resonance imaging (MRI)

It should be obtained when there is high clinical suspicion for EDH, accompanying a negative initial head CT scan. In the situation of a suspected spinal EDH, a spinal MRI is the preferred imaging modality, as it affords higher resolution versus a spinal CT.

In almost all cases, extradural hematomas are seen on CT scans of the brain. They are typically bi-convex (or lentiform) in shape, and most frequently beneath the squamous part of the temporal bone. EDHs are hyperdense, somewhat heterogeneous, and sharply demarcated.

Because the subdural space is not restricted by the skull suture lines, subdural hematomas appear crescent-shaped on CT, with the blood collection able to cross suture lines. This is an important distinction from epidural hematomas.

Medical personnel typically use computed tomography (CT) brain scans to diagnose an EDH, which appears as a dense mass that pushes the brain away from the skull. A magnetic resonance imaging (MRI) scan can also diagnose an EDH, although CT is faster and more commonly used for evaluating trauma patients.

Most people with a suspected subdural haematoma will have a CT scan to confirm the diagnosis. A CT scan uses X-rays and a computer to create detailed images of the inside of your body. It can show whether any blood has collected between your skull and your brain.

Magnetic resonance imaging (MRI) is currently the gold standard for diagnosis of spinal epidural hematoma. Nevertheless, prior to MRI, computed tomography (CT) was the predominant imaging modality.

The subdural hematoma generally appears as a crescent-shaped mass over the convexity adjacent to the inner table of the skull on computed tomography (CT) scans or adjacent to the dura matter on magnetic resonance images (MRI).

In almost all cases, extradural hematomas are seen on CT scans of the brain. They are typically bi-convex (or lentiform) in shape, and most frequently beneath the squamous part of the temporal bone. EDHs are hyperdense, somewhat heterogeneous, and sharply demarcated.

Typically crescentic (crescent moon-shaped, concave, banana-shaped) and more extensive than EDH, with the internal margin paralleling the cortical margin of the adjacent brain. As these occur in the subdural space, they cross sutures.

What is the imaging of choice for a subdural hematoma? ›

Chronic subdural hematoma (CSDH), which generally occurs in elderly patients, is a frequently diagnosed condition in neurosurgical departments. Computed tomography (CT) and magnetic resonance imaging (MRI) are the most preferred diagnostic modalities for CSDH assessment.

Subdural hematomas are recognized by their crescent shape overlying and compressing the brain. They are arbitrarily divided into three types: acute (< 4 days), subacute (4-21 days) and chronic (> 21 days). In the acute stage, blood is bright on CT.

Confirmation of correct placement of the catheter in the epidural space is often performed by fluoroscopic-guided injection of contrast medium during pain procedures. Contrast dye is injected to demonstrate typical epidural spread under fluoroscopy.

An epidural hematoma (EDH) is bleeding between the inside of the skull and the outer covering of the brain (called the dura mater).

Because epidural hematomas typically involve an artery, bleeding and increased intracranial pressure may occur much more rapidly, requiring more urgent intervention. In contrast, though still serious, subdural hematomas involve veins which tend to bleed and grow more slowly.

Brain CT is the gold standard in the diagnosis of traumatic brain injury. This is an easy technique to perform, which can help accurately diagnose intracranial bleeding (epidural hematoma, subdural hematoma, subarachnoid hemorrhage, cerebral hemorrhage), brain parenchymal contusion and cubital fracture.

confusion. personality changes, such as being unusually aggressive or having rapid mood swings. feeling drowsy and finding it difficult to keep your eyes open. speech problems, such as slurred speech.

Acute subdural hematoma usually occurs after severe, high-impact injuries and is often associated with contusions of the adjacent areas of the brain. If the subdural hematoma is small (<5 mm in thickness) and the patient is stable clinically, a period of observation may be reasonable.

First aid for an epidural hematoma is limited to taking care of any other injuries. Most importantly, pay attention if the person loses consciousness. Anybody who loses consciousness gets a ride to the hospital in an ambulance. Call 911 for anyone who gets knocked unconscious from a blow to the head.

What are the three types of subdural hematomas? ›

Delayed traumatic intracranial hemorrhage (DIH) can occur up to several weeks after trauma to the head [13] and was reported to occur more frequently in patients with ATT, ranging from 0.2% to 6% [14,15,16,17].

In a subdural hematoma, the blood seeps between the dura and the arachnoid layers. It collects inside the brain's tough outer lining. This bleeding often comes from a blood vessel that breaks within the space around the brain. This most often happens because of a head injury.

Current guidelines recommend an acute subdural hematoma (ASDH) with a thickness greater than or equal to 10 mm or a midline shift greater than or equal to 5 mm be evacuated regardless of Glasgow Coma Scale (GCS). A large craniotomy versus craniectomy is the preferred surgical treatment for ASDH.

Unlike epidural hematoma, SDH is not restricted by dural tethering at cranial sutures; SDH can cross suture lines and continue along the falx and the tentorium. However, it does not cross the midline because of meningeal reflections.

Notice on the diagram below how subdural hematomas cannot cross at the midline because they are bound by the falx. Epidural hematomas can cross at the midline because they are located above the dura.

Delayed acute subdural hematoma (SDH) is defined as an acute SDH that is not apparent on the initial computed tomography (CT) scan but appears on a repeat CT scan. Delayed acute SDH occurs is uncommon and mainly occurs in middle-aged and elderly persons who are either on anticoagulation or antiplatelet therapy.

A CT scan can quickly visualize fractures and uncover evidence of bleeding in the brain (hemorrhage), blood clots (hematomas), bruised brain tissue (contusions), and brain tissue swelling. Magnetic resonance imaging (MRI).

CT is the mainstay of imaging of acute TBI for both initial triage and follow-up, as it is fast and accurate in detecting both primary and secondary injuries that require neurosurgical intervention.

Chronic subdural hematoma may have a presentation similar to that of Parkinson disease. An acute presentation is also possible, as in the case of a patient who presents with a seizure. Headache and confusion appear to be the most common presenting features, occurring in as many as 90% and 56% of cases, respectively.

What is the Big 3 criteria for brain bleed? ›

BIG 3 injuries are >8 mm SDH, >8 mm EDH, >8 mm IPH, or “scattered” SAH and are managed with admission, a neurosurgery consultation and at least one scheduled repeat head CT.

Intracranial hemorrhage encompasses four broad types of hemorrhage: epidural hemorrhage, subdural hemorrhage, subarachnoid hemorrhage, and intraparenchymal hemorrhage.

Image depicts a fracture of the right frontal bone anterior to the coronal suture. Epidural hematomas can typically be distinguished from subdural hematomas by the biconvex shape of epidural hematomas, versus the crescent shape of the subdural hematoma.

Post-traumatic acute subdural hematomas generally appear hyperdense on a computed tomography scan. In the hyperacute stage, a subdural hematoma in rare cases appears heterogeneous with isodense images. This can pose a diagnostic problem and compromise patient care.

Subdural hematomas are recognized by their crescent shape overlying and compressing the brain.

The most obvious difference between a hematoma and a hemorrhage is that a hemorrhage may bleed externally. Hemorrhages may also bleed internally and this would not be visible. Hematoma symptoms may include bluish or purplish discoloration of the skin (a bruise) or a lump under the skin.

Skull radiographs may demonstrate the fracture responsible for an epidural hematoma, although vascular channels and suture lines may mimic skull fractures and make the diagnosis difficult. Furthermore, small, minimally displaced skull fractures can be difficult to diagnose.

The first clinical symptom of spinal epidural hematoma, in most of the cases, is sudden backpain or radicular pain, depending on the location of the bleeding. After hours to days of initiation of symptoms this insidiously progresses to a complete or partial paraplegia or even quadriplegia.

CT scan. This imaging test can detect bleeding in the brain. While a CT scan is a highly effective test when performed properly, the scan may not find the bleed if you have a low red blood cell count (anemia) and only a small amount of blood is lost during the bleed.

What should you do immediately after hitting your head? ›

Treating minor head injuries

You can hold a cold compress to their head – try a bag of ice or frozen peas wrapped in a tea towel. Seek immediate medical advice if symptoms such as mild dizziness and a headache get worse.

Epidural and subdural hematomas are traumatic brain injuries that both involve bleeding in the brain, but they have different locations and characteristics. Epidural hematomas are more immediate and easier to diagnose and treat. Not doing so can lead to neurological symptoms such as: Confusion.

MRI can establish the presence, location and extent of the haematoma, along with cord compression and concurrent injuries. Epidural haematoma is the most common location of haematoma in the spine.

Magnetic resonance imaging (MRI) is currently the gold standard for diagnosis of spinal epidural hematoma.

Typically, the hematoma is asymptomatic, but in rare cases it will compress the spinal cord, with potentially devastating neurological consequences. These symptoms include sensory disruption, bowel and bladder incontinence, motor weakness, or, in severe cases, complete paralysis of the affected limbs.