AnEpiduralHemorrhage

AnatomyandKeyConcepts

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AnatomyofanEpiduralBleed

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AnatomyofanEpiduralBleed
Themiddlemeningeal
arteryrunsdirectlybelow
thetemporalboneofthe
face
Ifthetemporalboneis
fracturedbyablowtothe
face,themiddlemeningeal
maybelacerated.
Ifthishappens,theartery
bleedsintowhatiscalled
theepiduralspace.

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AnatomyofanEpiduralBleed:
TheMeninges
Threemembranes(themeninges)envelopthebrain
andspinalcord:pia,arachnoid,anddura

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MeningealAnatomy

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AnatomyofanEpiduralBleed:
SpacesandPotentialSpacesin
theCNS

Theepiduralspace:

thespacebetweenthedura(theoutermostmembranecoveringthebrainandspinalcord)andskull,orthebony
vertebraethatformthespinalcanal.Inthespine,theepiduralspacecontainslymphatics,smallarteries,andthe
epiduralvenousplexus.Inthebraintheepiduralspaceisapotentialspace,meaningthatthespacedoesnotexist
undernormalconditions.

Thesubduralspace:
Thespacebetweentheduramaterandthearachnoidmater,thisisapotentialspaceinboththeskullandthespine.

Thesubarachnoidspace:
betweenthearachnoidmaterandthepiamater,thisspacecontainsthecerebrospinalfluid

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Concept:BleedingIntoaClosed
Space

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TheLucidInterval
Anepiduralhemorrhageisoftencharacterizedbythe
followingsequenceofevents:
Blunttrauma/ablowtothehead,followedby:
1)Initialconfusion,decreasedconsciousness,orlossof
consciousness
2)Alucidinterval(2050%):
abriefperiodoffullconciousness/restoredmentalstatus.Thepatient
seemsbacktohis/hernormalself.

3)Changeinmentalstatus+/unstablevitalsigns(bloodpressure,
heartrate):
thepatientbecomesconfused,somnolent(sleepy),mayhave
neurologicsignssuchashemiparesis,onedilatedpupil,maybecome
comatose.

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CushingsResponse
Bodysresponsetoincreasedintracranial
pressure(ICP):
Increaseinbloodpressure(Hypertension)
Decreaseinheartrate(Bradycardia)
Alteredrespiratoryrate

ICPcancompressbloodvesselsinthe
brain,blockoffoxygendelivery(ischemia),
andputpressureonthebrainstem.
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CushingsResponse

Hypertension
Bradycardia
Respiratory Rate
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TheBlownPupil

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TheMotorHomunculus

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