His pupils quickly became significantly worse at 6 mm and 2 mm, and he became unresponsive. A head CT revealed a large epidural hematoma with midline shift. After a period of observation, he became increasingly somnolent, and on repeat exam, his pupils were slightly unequal. A FDP is a grave prognostic sign following TBI commonly resulting in long term ophthalmological sequelae however, a favourable outcome is still attainable. He initially appeared well and was running around the triage room. 1 EDH most commonly occurs after spinal trauma or surgery and may arise in the anterior or posterior epidural space, but is more common posteriorly in the postoperative setting (Fig. Trauma or other injury to your head can cause your brain to bounce. Anisocoria (unequal pupils) Signs of herniation (fixed and dilated pupil). ![]() Most patients with bilateral FDP did not survive (88%) however, of those who did survive, none was left in a persistent vegetative state or with any ophthalmological sequelae. Spinal epidural hematoma (EDH) is a collection of blood that accumulates in the spinal canal outside of the dural sac, usually from epidural venous hemorrhage. An epidural hematoma occurs when a mass of blood forms in the space between your skull and the protective covering of your brain. An extradural haematoma (EDH) is a collection of blood in the extradural. Of those patients who survived an FDP, 72% were left with some form of ophthalmological deficit. However, it can be caused by other things. Up to 20 percent of people with head injuries have an epidural hematoma. This is commonly caused by trauma, such as a vehicle accident. Skull fractures occur in 85-95 of adult cases, but they are much less common in children because of the plasticity of the immature calvaria. Epidural hematomas (EDHs) and subdural hematomas (SDHs), or so-called extra-axial bleedings, are common clinical entities after a traumatic brain injury. An epidural hematoma is a brain hemorrhage that occurs when an artery bursts between the dura (the outermost layer of meninges surrounding the brain) and the cranium. In 34% of cases CT demonstrated a lateralising condition ipsilateral to the side of the FDP and in 9% cases the FDP was contralateral to the side of the CT abnormality. Epidural hematoma usually results from a brief linear contact force to the calvaria that cause separation of the periosteal dura from bone and disruption of interposed vessels due to shearing stress. In patients presenting with a unilateral FDP, the CT-defined condition was most commonly diffuse brain injury (49%) with no obvious lateralising condition. ![]() In approximately three-quarters of cases, some form of road traffic incident was the mechanism of injury. What are the symptoms of Epidural hematoma. The objectives of this study were to determine the underlying condition responsible, the natural history of recovery of third nerve palsy and the ultimate clinical outcome in 60 patients admitted to a regional neurosurgical centre with a diagnosis of TBI and unilateral or bilateral fixed, dilated pupils (FDP). Pupillary abnormalities are commonly seen in patients presenting with severe traumatic brain injury (TBI).
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