EDH.pptx

ilmiah

1. Epidural Hematoma Dr. Vandy Ikra Departemen Bedah RSMH/FK Unsri Pendidikan Dokter Spesialis-1 Ilmu Bedah

2. an extra-axial collection of blood within the potential space between the outer layer of the dura mater and the inner table of the skull It is a life-threatening condition, which may require immediate intervention and can be associated with significant morbidity and mortality if left untreated Rapid diagnosis and evacuation are important for a good outcome Departemen Bedah RSMH/FK Unsri Pendidikan Dokter Spesialis-1 Ilmu Bedah refference : https://www.ncbi.nlm.nih.gov/books/NBK518982/

3. Etiology Traumatic Trauma Brain Injury Mechanisme Motor vehicle collisions Physical assaults Acidental falls Non traumatic Mechanism Infection/Abscess Coagulopathy Hemorrhagic Tumors Vascular Malformations Departemen Bedah RSMH/FK Unsri Pendidikan Dokter Spesialis-1 Ilmu Bedah refference : https://www.ncbi.nlm.nih.gov/books/NBK518982/

4. occurs in 2% of all head injuries and up to 15% of all fatal head traumas Males are more often affected than are females the incidence is higher among adolescents and young adults The mean age of affected patients is 20 to 30 years Departemen Bedah RSMH/FK Unsri Pendidikan Dokter Spesialis-1 Ilmu Bedah Epidemiology refference : https://www.ncbi.nlm.nih.gov/books/NBK518982/

5. Arterial Injury 85% of all bleeding Branch of the middle meningeal artery Anterior meningeal artery or dural arteriovenosus fistula at the vertex maybe involved Departemen Bedah RSMH/FK Unsri Pendidikan Dokter Spesialis-1 Ilmu Bedah Pathophysiology refference : Greenberg, M.S., 2016. Handbook of neurosurgery. 8th edn New York.

6. Venous Injury Up to 10% are due to venous bleeding following the laceration of dural venous sinus In adults, 75% EDHs occur in the temporal region In children, they occur with similar frequency in the temporal , occipital , frontal , and posterior fossa regions . Departemen Bedah RSMH/FK Unsri Pendidikan Dokter Spesialis-1 Ilmu Bedah refference : https://www.ncbi.nlm.nih.gov/books/NBK518982/

7. An initial loss of consciousness a complete transient recovery (“often termed as a lucid interval”) rapid progression of neurological deterioration Cushing Reflex Departemen Bedah RSMH/FK Unsri Pendidikan Dokter Spesialis-1 Ilmu Bedah History and Physical refference : https://www.ncbi.nlm.nih.gov/books/NBK518982/

8. Subdural hematoma A posttraumatic disorder described by Denny-Brown consisting of a “lucid interval” followed by bradycardia , brief periods of restlessness and vomiting , without intracranial hypertension or mass Departemen Bedah RSMH/FK Unsri Pendidikan Dokter Spesialis-1 Ilmu Bedah Differential Diagnosis refference : Greenberg, M.S., 2016. Handbook of neurosurgery. 8th edn New York.

9. CT Scan biconvex or lens-shaped mass on brain CT scan estimating the amount of blood present in an EDH : ABC/2 A: The maximum hemorrhage diameter on the CT slice with the largest area of hemorrhage B: The maximum diameter 90 degrees to A on the same CT slice C: The number of CT slices with hemorrhage multiplied by the slice thickness in centimeters Swirl sign Departemen Bedah RSMH/FK Unsri Pendidikan Dokter Spesialis-1 Ilmu Bedah Evaluation refference : https://www.ncbi.nlm.nih.gov/books/NBK518982/

10. MRI Assessing for EDH in the vertex and spinal EDH Angiogrhapy Assessing for EDH in the vertex Laboratory test : INR, PTT, PT, LFT Departemen Bedah RSMH/FK Unsri Pendidikan Dokter Spesialis-1 Ilmu Bedah Evaluation refference : https://www.ncbi.nlm.nih.gov/books/NBK518982/

11. Neurosurgical Consultation & stabilize the patient -> ABCs Operative Management Craniotomy and Hematoma Evacuation Non Operative Management close observation with repeated neurological examinations and continuous surveillance with brain imaging follow-up head CT scan within 6 to 8 hours following brain injury. Departemen Bedah RSMH/FK Unsri Pendidikan Dokter Spesialis-1 Ilmu Bedah Treatment/Management refference : https://www.ncbi.nlm.nih.gov/books/NBK518982/

12. Departemen Bedah RSMH/FK Unsri Pendidikan Dokter Spesialis-1 Ilmu Bedah Indications for surgery Level III * EDH volume > 30 cm 3 should be evacuated regardless of GCS EDH with the all of the following characteristics can be managed nonsurgically with serial CT scans and close neurological observation in a neurological center Volume < 30 cm 3 and thickness < 15 mm and with midline shift (MLS) < 5 mm and GCS > 8 and no focal neurologic deficit *Level III : its is strongly recommended that patients with an acute EDH and GCS <9 and anisocoria undergo surgical evacuation ASAP refference : Greenberg, M.S., 2016. Handbook of neurosurgery. 8th edn New York.

13. Treatment/Management Indications Operative Management Acute EDH Hematoma volume greater than 30 ml regardless of Glasgow coma scale score (GCS) GCS less than 9 with pupillary abnormalities like anisocoria Indication NonOperative Management EDH volume of less than 30 ml Clot diameter of less than 15 mm Midline shift of less than 5 mm GCS greater than 8 and on physical examination, shows no focal neurological symptoms. Departemen Bedah RSMH/FK Unsri Pendidikan Dokter Spesialis-1 Ilmu Bedah refference : https://www.ncbi.nlm.nih.gov/books/NBK518982/

14. Departemen Bedah RSMH/FK Unsri Pendidikan Dokter Spesialis-1 Ilmu Bedah Terima Kasih