Rahimi-Movaghar Vafa, Bahmani Hamid, Hajiqasemi Mohsen
Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2025 Jan 16;39:10. doi: 10.47176/mjiri.39.10. eCollection 2025.
Acute epidural hematoma (AEDH) is a critical condition commonly resulting from trauma, particularly in young males aged 20 to 30 years. It arises from the accumulation of blood between the dura mater and the skull, leading to increased intracranial pressure (ICP) and various neurological symptoms. Early mechanisms, such as cerebrospinal fluid (CSF) shift and vasoconstriction, temporarily stabilize ICP, but as the hematoma grows, these compensatory processes fail. This failure results in a rapid progression of symptoms, including localized pain, nausea, vomiting, and, in severe cases, loss of consciousness or herniation.
Clinical presentations depend on the compression location, such as the "talk and die" phenomenon in posterior fossa AEDH or motor impairments due to subfalcine herniation. Advanced stages are marked by Cushing's triad and posturing changes, indicating imminent herniation. Prompt recognition and intervention, typically surgical evacuation through craniotomy for indicated cases, are crucial for preventing mortality. Medical management focuses on controlling ICP through positioning and osmotic agents.
Awareness of clinical symptoms and rapid treatment are vital for improving patient outcomes in this potentially fatal disorder.
急性硬膜外血肿（AEDH）是一种危急情况，通常由外伤引起，尤其是在20至30岁的年轻男性中。它是由于硬脑膜与颅骨之间血液积聚所致，导致颅内压（ICP）升高和各种神经症状。早期机制，如脑脊液（CSF）移位和血管收缩，可暂时稳定颅内压，但随着血肿增大，这些代偿过程失效。这种失效导致症状迅速进展，包括局部疼痛、恶心、呕吐，严重时可出现意识丧失或脑疝。
临床表现取决于压迫部位，如后颅窝AEDH中的“交谈后死亡”现象或镰下疝导致的运动障碍。晚期以库欣三联征和姿势改变为特征，提示即将发生脑疝。对于确诊病例，及时识别并进行干预，通常通过开颅手术进行血肿清除，对于预防死亡至关重要。药物治疗侧重于通过体位和渗透剂控制颅内压。
了解临床症状并迅速治疗对于改善这种潜在致命疾病的患者预后至关重要。
