Emergency Surgery for Bleeding After a Head Injury
If someone has a head injury, especially if they were knocked out, seemed fine, and then become drowsy, confused, vomit or develop a worsening headache or weakness, call 911 immediately. An epidural hematoma can become life-threatening within hours.
An epidural hematoma is one of the true emergencies in neurosurgery, and one where fast surgery makes an enormous difference. Epidural hematoma evacuation can often correct the problem by removing the blood clot before it causes lasting damage.
What Is Epidural Hematoma Evacuation?
An epidural hematoma is a collection of blood between the skull and the dura, the tough covering of the brain. It usually happens when a skull fracture tears an artery, so the blood collects quickly and presses on the brain. Evacuation is emergency surgery to remove the clot and stop the bleeding.
People with an epidural hematoma sometimes have a “lucid interval”: they are knocked out, wake up and seem fine, then get rapidly worse as the blood builds up. That’s why anyone with a significant head injury should be checked in an emergency room.
Who Needs Epidural Hematoma Evacuation?
- An epidural hematoma that is large, shifts the brain or is causing symptoms
- Drowsiness, confusion, a worsening headache, vomiting, weakness or a widened pupil after a head injury
- A hematoma that grows on repeat CT scans
Very small epidural hematomas without symptoms are sometimes watched closely in the hospital with repeat CT scans, but most need surgery.
How Epidural Hematoma Evacuation Is Done
- Emergency anesthesia: You’ll be fully asleep. Surgery is done as quickly as possible.
- Craniotomy: A section of skull over the clot is lifted.
- Removing the clot: The blood clot is removed and the bleeding artery is sealed.
- Securing the dura: Stitches hold the dura up against the skull to help prevent new bleeding.
- Closing: The bone is replaced with small plates and screws, any skull fracture is repaired, and the scalp is closed. A small drain may be left for a day or two.
Watch Dr. Grunch explain an epidural hematoma case:
Video: Case Study 56, Epidural Hematoma, presented by Dr. Grunch on her Ladyspinedoc channel (YouTube)
And an epidural hematoma caused by an ATV accident:
Video: Case Study 109, ATV Accident Causing Epidural Hematoma, explained by Dr. Grunch on her Ladyspinedoc channel (YouTube)
Benefits and Risks
Benefits
- Removes the pressure on the brain before it causes permanent damage
- Can be lifesaving
- When surgery is done quickly, many patients make an excellent recovery
Risks
- New bleeding or a hematoma that comes back
- Infection
- Seizures
- Brain injury from the original trauma, which may not fully recover
- Risks related to emergency anesthesia
What to Expect
In the hospital
Epidural hematoma evacuation is done as an emergency, often within hours of the injury. Your care team will explain the situation to your family as quickly as they can. After surgery, most patients start in the intensive care unit and stay in the hospital for several days, longer if there are other injuries. Physical, occupational and speech therapy may help with recovery.
Recovery timeline
- First days: Close monitoring and a repeat CT scan.
- Two weeks: Stitches or staples are removed.
- Four to six weeks: A follow-up visit to check your incision, symptoms and return to activities.
- Beyond: Headaches, fatigue and trouble concentrating can last for weeks to months, especially if there was also a concussion or brain contusion.
Caring for yourself at home
- Your incision: You can usually shower after two to three days. Let water run gently over the incision and pat it dry. Don’t scrub, soak in a bath or pool, or use hair dye or harsh hair products until it has fully healed. Staples or stitches are usually removed in 10 to 14 days.
- Activity: Walk every day and rest when you’re tired. Avoid heavy lifting, bending over and straining for about four to six weeks, and avoid contact sports until you are cleared.
- Medications: Take any seizure medication exactly as prescribed and don’t stop it on your own. Don’t take blood thinners, aspirin or anti-inflammatory medications such as ibuprofen until your surgical team tells you it’s safe. Take pain medication with food, avoid alcohol and use a stool softener so you don’t strain.
- Driving: Don’t drive until you are cleared. If you have had a seizure, Georgia law limits driving for a period of time.
- Recovery at home: Fatigue, headaches and trouble concentrating are common for several weeks. Have someone stay with you for the first few days.
Call Dr. Grunch’s office at 470-293-9800, or the surgeon who treated you in the hospital, if you have a fever over 101°F, redness, swelling or drainage from the incision, clear fluid leaking from the incision or nose, or calf pain or swelling. Call 911 for a seizure, a sudden severe headache, new confusion or drowsiness, new weakness or numbness, trouble speaking, chest pain or shortness of breath.
Frequently Asked Questions
How quickly does surgery need to happen?
As quickly as possible. An epidural hematoma can grow rapidly, and outcomes are best when the clot is removed before the brain is badly compressed.
Will the person recover fully?
Many people recover very well when surgery is done quickly, especially if they were awake before surgery. Recovery depends on how much pressure the brain was under and any other injuries.
What is a lucid interval?
It’s a period after a head injury when a person seems fine before suddenly getting worse as the blood collects. It’s one reason every significant head injury should be checked.
Can it come back?
It’s uncommon once the bleeding vessel is sealed, but a repeat CT scan is done after surgery to make sure.
When can I return to sports?
Not until you are cleared after surgery. Contact sports usually need to wait several months.
Follow-Up Care After Hospital Treatment
For a new head injury or sudden symptoms, call 911 or go to the nearest emergency room.
An epidural hematoma is diagnosed and treated as an emergency in the emergency room and hospital. After you go home, follow-up with Dr. Grunch or the surgeon who treated you in the hospital is an important part of recovery, including repeat imaging, checking your incision and guidance on returning to work, driving and normal activities. If Dr. Grunch cared for you in the hospital, or you’ve been referred for follow-up, call 470-293-9800 to schedule your visit or contact us online.
We see patients across metro Atlanta and North Georgia at our offices in Gainesville, Sandy Springs and South Atlanta (Riverdale). Find the office nearest you.
Related pages: Epidural hematoma · Skull fractures · Subdural hematoma evacuation · Skull fracture repair · Concussion
This page is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. If you or someone else has a head injury with confusion, worsening headache, repeated vomiting, a seizure, unequal pupils, weakness or trouble waking up, call 911 or go to the nearest emergency room.