Epidural hematoma natural history, complications and prognosis

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

If left untreated, patients with epidural hematoma may progress to develop permanent paraplegia, loss of sensation, brain herniation, coma and death. Common complications of epidural hematoma include: brain herniation, death, post-traumatic seizures, visual problems, persistent paraplegia, Coma, loss of sensation, priapism, disturbed circulation of the cerebrospinal fluid and Urinary retention. Prognosis is generally good in patients treated surgically without delay. In patients with acute epidural hematoma the surgery in an interval under two hours leads to 17% mortality rate and 67% of good recoveries but in patients who recover after an interval of more than two hours the mortality rate is 65% and good recovery rate is 13%. Overall mortality rate of patients with epidural hematoma is approximately 25%. The percentages of overall good recoveries and minimal neurologic deficit in patients with epidural hematoma is approximately 58%. The prognosis is worse in older patients and in patients with concomitant injuries of other body regions.

• If left untreated, patients with epidural hematoma may progress to develop permanent paraplegia, loss of sensation, brain herniation, coma and death.^{[1][2][3][4][5]}

• Common complications of epidural hematoma include:
  • Brain herniation^[4]
  • Death^[6]
  • Post-traumatic seizures^[7]
  • Infarction of the brain tissue which may cause:
    • Visual problems^[8]
    • Persistent paraplegia^[2][3]
    • Coma^[5]
    • Loss of sensation^[1]
    • Priapism^[1]
  • Disturbed circulation of the cerebrospinal fluid^[9]
  • Urinary retention^[10]

• Prognosis is generally good in patients treated surgically without delay.^[11]
• In patients with acute epidural hematoma the surgery in an interval under two hours leads to 17% mortality rate and 67% of good recoveries but in patients who recover after an interval of more than two hours the mortality rate is 65% and good recovery rate is 13%.^[12]
• Overall mortality rate of patients with epidural hematoma is approximately 25%.^[12]
• The percentages of overall good recoveries and minimal neurologic deficit in patients with epidural hematoma is approximately 58%.^[12]

• The prognosis is worse in older patients and in patients with concomitant injuries of other body regions.^[12]

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