American Medical Association Family Medical Guide - American Medical Association [421]
Epidural Hemorrhage
Epidural hemorrhage occurs when blood vessels rupture outside or in the dura mater (the outermost of the three membranes that cover the brain) and blood leaks into the space between the dura mater and the skull. The condition usually results from a head injury that causes some of the blood vessels in the outer surface of the dura mater to rupture. Because these vessels are usually arteries, a significant amount of blood can leak into the space.
Symptoms
The symptoms of an epidural hemorrhage may develop up to a few hours after a head injury. These symptoms can include a headache that increases in severity, nausea and vomiting, and increasing drowsiness and weakness, which eventually can lead to unconsciousness, coma, and death.
WARNING!
Brain Hemorrhage
If you or someone you know has symptoms of an epidural hemorrhage, call 911 or your local emergency number immediately, or take the person to the nearest hospital emergency department without delay, especially after a blow to the head within the past 24 hours. Without prompt treatment, bleeding in the brain can cause permanent brain damage or death.
Diagnosis
A person who reports to a hospital emergency department with symptoms of a head injury will be evaluated immediately with diagnostic tests to determine the severity of the injury and its effects.
Treatment
If the injury has caused an epidural hemorrhage, the doctor will perform surgery immediately to stop the bleeding and relieve pressure on the brain. With prompt surgical treatment, most people recover completely from an epidural hemorrhage.
Structural Disorders of the Brain and Spinal Cord
A structural disorder of the central nervous system occurs when part of the brain or spinal cord is distorted, malformed, or damaged. These problems can result from an injury, a tumor, or a disorder that affects the tissues, membranes, or adjacent bones. Some people are born with malformed blood vessels in the brain that may not cause any symptoms until later in life.
Arteriovenous Malformations
Arteriovenous malformations are congenital (present at birth) abnormalities of blood vessels that can occur in any part of the brain or spinal cord. The blood vessels are tangled, and there may be abnormal connections between arteries and veins, with fewer capillary connections than normal. Pressure can build up in these blood vessels and cause blood to leak into the brain. An arteriovenous malformation that causes a subarachnoid hemorrhage (see page 677) or bleeding into the brain or spinal cord can cause permanent damage or be fatal.
Symptoms
Although people are born with arteriovenous malformations, most do not cause symptoms for years. Symptoms such as recurring headaches and seizures develop when the malformation starts leaking blood into the brain or spinal cord or the subarachnoid space (the space between the middle and inner layers of membranes covering the brain and spinal cord). The damage that causes the seizures may be limited to only one part of the brain. These seizures may not always cause unconsciousness but can cause intermittent symptoms such as uncontrollable twitching in a part of the body controlled by the area of the brain in which the malformation is located.
Diagnosis
If you have symptoms of an arteriovenous malformation, your doctor may recommend that you have a CT scan (see page 112) or MRI (see page 113) and possibly an MRA (magnetic resonance angiogram) to look for abnormal blood vessels.
Treatment
Doctors usually use a combination of treatments for arteriovenous malformations. Leaking blood vessels in a malformation can sometimes be removed surgically or closed to cut off their blood supply. For some malformations, doctors inject an acrylic material through the arteries in the brain into the malformation to destroy all of it or, in some cases, to eliminate the most fragile parts of the malformation that are at risk of leaking. For malformations that are not easy to