An epidural hematoma is localized bruising stemming from burst blood vessels involving blood pooling between the skull and the dura membrane of the patient. Epidural hematomas are the least clinically traumatic initially of the five known intraventricular hemorrhage types linked closely to later onset of cerebral palsy in neonatal patients. Specifically, epidural hematomas consist of either venous or arterial ruptures in a localized context of the brain and cranium, with the resulting internal bleeding resulting in pressure on the brain, while threatening the continued functioning of these impacted brain areas. Moreover, the external trauma pressure required to cause an epidural hematoma, in the vast majority of cases, results in a cranial fractures in patients.
Epidural Hematoma and Cerebral Palsy
In virtually any case of diminished oxygenation of the brain in pre or post-term infants, cerebral palsy poses a long-term risk complication. In instances of epidural hematoma’s requiring surgical intervention to relieve cranial pressure, or hydrocephalus, post-operative care must consider the continued monitoring for the onset of cerebral palsy symptoms in neonatal patients. As the source of hemorrhaging in epidural hematomas in the skull are most likely arteries, rapid expansion and pressure-build up from epidural hematomas requires an immediate, emergency medical response in most cases. Ultimately, confirmation or denial of the presence of an epidural hematoma requires CT or an MRI.
In most cases, epidural hematomas and other intraventricular hemorrhages in infants present an immediate and well known risk to medical professionals concerning the potential implications regarding cerebral palsy in light of potential cerebral oxygen deprivation. Infant oxygen deprivation in any form is a closely linked risk factor associated with permanent brain damage, such as that found in cerebral palsy patients. In any case of an epidural hematoma in an infant, if intracranial pressure or other risk-factors of brain damage warrant it, medical professionals will consider and likely perform a craniotomy to intervene and permit cranial pressure to recede.
Known Risk Factors that Increase the Likelihood of Epidural Hematomas in Infants
Specifically, epidural hematomas and other forms of intraventricular and intracranial hemorrhaging are closely associated with the following risk factors including:
- Fetal or maternal coagulation or blood clotting complications
- Fetal or maternal blood pressure disorders
- Premature birth of the infant
- Complicated birth involving the proportionally intense use of surgical tools
- Known or suspected instances of physical trauma to the child, including shaken infant syndrome
- Vascular or arterial abnormalities in the infant at the time of birth
In most cases, these potential risk factors should be known in advance to medical professionals, with special deference given to their role in increasing infant risk of developing an epidural hematoma. Moreover, a well-known medical phenomena, known as spontaneous spinal epidural hematoma during childbirth poses an ongoing risk to every childbirth performed in the United States, but generally, exhibits a low annual rate of incidence relative to external trauma or iatrogenic care as the proximate causes of the spinal bleeding.
Epidural Hematomas of the Spine
In a limited number of instances annually, hematomas of the epidural membrane in the patient’s spine develop in light of bleeding reaching this body space. Pressure from the spinal epidural hematoma is known to occur spontaneously and quickly in cases of childbirth, as well as during cases of patients undergoing epidural anesthesia. Unlike cranial epidural hematomas, the source of bleeding in spinal epidural hematomas generally originates with the veins, as well as differs in the presentation of symptoms. Unlike the lucid period followed by gradual loss of consciousness found in cranial epidural hematomas, spinal epidural hematomas present as back discomfort and incontinence issues in patients, ultimately requiring a CT scan evaluated by medical professionals to confirm the diagnosis and commence to attenuate the pressure on the patient’s spinal cord.
Resources:
http://www.mayoclinic.org/diseases-conditions/intracranial-hematoma/basics/causes/con-20019654
http://pediatrics.aappublications.org/content/105/3/549
