Epidural Bleed (Haemorrhage) Explained for Africans: Causes, Symptoms, Treatment and Prevention Tips
By: Glory Ngokere, B.Sc. Psychology. Freelance health writer and DLHA Volunteer. Medically reviewed by: A. Odutola, MBBS, PhD, FRCSEd.
A tear in the middle meningeal artery in the skull after head trauma results in an epidural bleed (haemorrhage) into the potential epidural space of the coverings of the brain. Click on image to enlarge.
An epidural bleed (or haemorrhage) at the level of the brain, occurs when an injury or blow to the skull tears an artery supplying the outermost tough covering of the brain (dura mater), causing blood to form in the space (epidural space) between this covering and the inner table of the skull.
When an epidural bleed occurs at the level of the spine, it is called spinal epidural bleed (haemorhhage)..
An epidural bleed no matter at which level it occurs, is often a life-threatening condition that requires emergency treatment and is associated with a significant disability and death if not diagnosed and treated promptly.
This article focuses on providing you with accurate, basic and simplified information on epidural bleed in the brain - helping you understand its severity, recognize mild vs. severe symptoms, identify causes, and apply prevention tips. Most critically, it stresses the need for prompt medical care after traumatic brain injury.
Before diving into the topic, let us explore the coverings (meninges) and spaces around the brain in order to know how and where an epidural bleed forms.
Fig. 1: Cartoon illustration showing cross-sectional view of the scalp, skull, and coverings of the brain (meninges). Image credit: Wikipedia. Click on the image to enlarge.
Your brain and spinal cord within the skull and back bones respectively, are covered and protected by sheets of tissues (called meninges) that are made up of three layers (from outside inwards) as follows: [1] See fig. 1.
Dura mater: This is the outermost covering layer of the brain. It’s tough, and made up of two layers that are strongly bound to one another. [1]
Arachnoid mater: This is the middle layer sheet. It is a web-like structure filled with fluid (cerebrospinal fluid) that cushions and protects the brain.
Pia mater: This is the innermost covering layer. It is very thin and delicate and intimately binds the jelly-like brain and spinal cord.
Fig. 2: Cartoon illustration of spaces between the coverings (meninges) of the brain. Click on the image to enlarge.
Three important spaces are associated with the three layered coverings of the brain and spinal cords as follows:
This is a potential (tight) space that is located between the tissue lining the inner surface of the skull (periosteum) and the dura mater. Within this space, is a blood vessel called the middle meningeal artery (MMA) that supplies blood to the dura mater and the inner table of the skull bones.
This is a real space that is found between the inner surface of the dura mater and the arachnoid mater. It contains many blood vessels (bridging veins) that return blood from the brain or spinal cord into the general circulation of the body. When the bridging veins are damaged blood escapes into the subdural space to form what is referred to as subdural bleed/haemorrhage or haematoma. The commonest cause of a subdural bleed is also from head injury.
This space lies between the arachnoid and pia mater. It contains a clear and colourless fluid called cerebrospinal fluid that helps to protect the brain, nourish the arachnoid and clear waste products from the brain into the general body circulation. The vessels (arteries and veins) that carry blood to and from the brain and spinal cord are found in this space and a tear in the vessels will cause a subarachnoid bleed or haemorrhage. The commonest causes of subarachnoid bleed are head injury, hypertension or tear occurring in a weak spot in a vessel wall.
Fig. 3: Showing the location of the middle meningeal artery in the skull and how a tear in the artery after head trauma results in an epidural bleed (haemorrhage) into the potential epidural space of the coverings of the brain. Click on image to enlarge.
An epidural bleed, also known as epidural haemorrhage or epidural haematoma, is the build-up of blood into the potential epidural space. When a part of the middle meningeal vessels (especially an artery) ruptures, commonly due to trauma to the head from falls, direct assault or motor vehicular collision, it causes blood to leak and clot in the epidural space (See fig. 3). When the bleed accumulates, it forms a pocket that swells and causes pressure on the brain, damaging brain functions and may lead to serious complications if not promptly treated. [2] When an epidural bleed occurs in the spinal cord, it is referred to as spinal epidural bleed.
Yes, an epidural bleed can be a life-threatening condition that requires immediate medical attention to prevent permanent brain damage or death. Numerous studies have shown that epidural bleed is one of the leading causes of mortality and disability worldwide. Delayed treatment or severe injuries have resulted in mortality rates in up to 15% of cases, while a significant proportion of survivors experience long-term disability. [3, 4] Some symptoms that indicate an emergency include loss of consciousness, seizures, difficulty breathing or speaking, or abnormal pupil reactions.
Related: Unexpected, Sudden Natural Death in Young African Adults: Causes
An epidural bleed is commonly caused by a trauma to the head. Typically, there’s a break (fracture) in the bone of the skull (commonly the side in adults) leading to a tear in the middle meningeal artery. Studies indicate that males are more likely to suffer from this type of injury, with motor vehicular collision being the most common cause. [5]
Other trauma conditions causing epidural bleed include:
Rare and non-trauma causes of an epidural bleed include:
In rare cases, an epidural bleed can develop after a neurosurgical procedure. This occurs if a blood vessel is damaged during the surgery.
Although anyone who experiences a traumatic brain injury due to accidents or physical assault can develop an epidural bleed, the following conditions increase your risks of suffering trauma and an epidural bleed:
The symptoms of an epidural bleed can vary from person to person depending on the severity of the trauma. The most common signs and symptoms that may develop immediately or a few hours after a traumatic head injury include:
These symptoms and signs can appear immediately or have a delayed onset and they can worsen with time progressing to more severe complications including:
Fig. 4: CT scan of the head showing an epidural bleed in different views after a motor vehicular injury. Click on image to enlarge..
When an epidural bleed is suspected, doctors will:
Sometimes, symptoms of an epidural bleed don’t appear right after a head trauma. Head injuries can trigger delayed bleeding symptoms that worsen hours to days after trauma.
The following symptoms are often indicators of progressive bleeding: [6]
If you notice any of these symptoms following a traumatic brain injury, you should see your doctor immediately as symptoms can worsen rapidly and lead to more severe complications.
Related: 12 Signs That Might Indicate Your Headache Is Serious
Epidural bleeds usually require emergency surgery to stop the bleeding (if still active), remove the blood clot and relieve pressure on the brain. A traumatic head injury that ruptures a blood vessel instantly upon impact can lead to a rapid loss of brain function. So, immediate medical attention is required to prevent permanent brain damage or death.
Treatment options of epidural bleeds include:
This procedure involves drilling one or more small holes in your skull to drain blood through a tube (catheter). This approach is usually used for a minor bleed that isn’t putting significant pressure on the brain.
Craniotomy is the preferred procedure for treating an epidural bleed. It is a type of brain surgery that involves removing a portion of the skull bone to provide better access to the brain for purposes of stopping an active bleed, or removing clotted blood and relieving pressure on the brain. [7] The skull piece is reattached using small metal plates and screws at the end of the surgery.
Your doctor might prescribe medications that help to reduce your headache, brain swelling, seizures (uncontrolled shaking/fits), and intracranial pressure before and after surgery. These medications belong to various classes and help manage symptoms and prevent complications. [8]
Taking your prescribed medications as directed by your doctor helps to minimize further complications and ensure quick recovery.
Supportive Care
If you have suffered brain damage after an epidural bleed (haemorrhage), your doctor (neurologist) or neurosurgeon) may order the following therapy for you in the period immediately after your surgical treatment or after your discharge:
In mild cases, patients may be monitored closely in the Intensive Care Unit (ICU) with repeated neurological examinations to ensure the condition doesn’t worsen. Over time, your body can gradually absorb small bleeds that aren’t putting pressure on the brain.
The healing process can take several weeks to a few months. You’ll be closely monitored until the bleed fully heals.
In severe cases and after being discharged from the hospital, your doctor may give you scheduled appointments to come into the hospital for assessment to make sure your healing process is occurring without further problems.
Various factors influence the outcome of an epidural bleed such as
Early diagnosis and prompt treatment are crucial for promising outcomes, whereas late diagnosis and treatment may lead to permanent brain damage, disability or death.
Yes, you can make a full recovery if treated promptly and properly. However, in severe cases or in cases where treatment was delayed, there's a high possibility of long-term effects like seizures (uncontrollable shaking or fits), memory or coordination issues, etc.
Regular checkups with your doctor and also following your prescribed treatment and medications are essential for preventing further complications and ensuring full recovery.
Depending on the severity, epidural bleed can sometimes cause long-term physical, psychological/mental health, or higher brain function (cognitive) complications that may prevent you from returning to your normal lifestyle after surgical treatment. [9]
Epidural bleed can lead to the following physical outcomes:
Epidural bleed can have the following psychological effects:
Severe epidural bleed can lead to memory, attention, decision making or concentration issues such as:
If any of the mentioned complications occur after epidural surgery, your doctor may refer you to other specialists like psychiatrist, psychotherapist, etc., depending on your specific symptoms, to guide and support you through your recovery.
The survival rate in epidural bleeds (haemorrhage) in Sub-Saharan Africa is not well documented. But various studies out of Africa have shown a significant survival rate with early surgical treatment whereas delayed treatment reduces your chances of survival or full recovery.
Diagnosis and treatment within 1 or 2 hours of a suspected epidural bleed tend to yield more favorable outcomes.
Anyone can develop an epidural bleed and although injuries and accidents aren’t entirely within your control, you can greatly minimize your chances of suffering an epidural bleed by taking the following precautionary measures:
Due to several factors, challenges of care of patients with epidural bleeds abound in African countries. Investment in preventive public health education would provide substantial benefits and significantly help to reduce the occurrence of and the death and disabilities associated with the condition.
Seeking medical attention after a head trauma is strongly advised even if you feel fine. Sometimes bleeding can start days after trauma and worsen quickly or over time. Do not self-diagnose or leave it to chance. Always seek proper diagnosis after any head trauma to rule out the possibility of any type of intracranial bleeding, including epidural bleeding.
Epidural bleed is a serious condition commonly caused by traumatic head injuries such as from a motor vehicular accident or physical assault. These injuries are usually associated with fracture of the skull bones and can rupture blood vessels leading to bleeding into the epidural space.
Epidural bleed often requires prompt medical attention to prevent brain damage or death. It is mainly treated by a surgical procedure called craniotomy.
It is important to note that in some cases, symptoms may not appear immediately after the injury. Symptoms such as severe headache, dizziness, confusion, fatigue, nausea, and vomiting, can develop hours or days after the injury. These delayed onset signs usually indicate progressive bleeding, which is why it’s essential to get checked after any head injury no matter how minor it seems.
While anyone can develop an epidural bleed following a head injury, there are certain risk factors. These include being male, engaging in high-risk activities like contact sports, biking, or motorcycling, driving under influence and having conditions like coagulopathy (blood clotting disorders).
Stay informed and take preventive measures to protect yourself and your loved ones from injury. It may sound so basic as to be taken for granted; prevention is still better than cure. Always wear protective equipment during high-risk activities or in hazardous environments and don’t forget to follow traffic rules to minimize the risk of motor vehicular injuries.
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2. Cleveland Clinic. Epidural hematoma [Internet]. Cleveland, OH: Cleveland Clinic; Last reviewed 2021 Nov. 10. [Cited 2025 Feb 09]. Available from here
3. Svoboda N, Tyll T, Beneš V, Netuka D. Epidural hematoma - benign or potentially malignant disease?. Epidurální hematom: benigní, nebo potenciální maligní onemocn?ní?. Rozhl Chir. 2018;97(6):267-272. English abstract available from here
4. Rahimi A, Corley JA, Ammar A, Shlobin NA, Rolle M, Mekary RA, Park KB. The unmet global burden of cranial epidural hematomas: A systematic review and meta-analysis. Clinical Neurology and Neurosurgery, 2022, 219,107313. doi: 10.1016/j.clineuro.2022.107313. Available from here
5. Khairat A, Waseem M. Epidural Hematoma. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan [Updated 2023 July 31]; cited 2025 Feb 9. Available from here
6. Ziechmann R, Pathak SM, Welch J, Villanueva P. Delayed Traumatic Intracerebral Hematoma: A Pathophysiological Classification and Literature Review. Cureus. 2023;15(8):e42987. doi:10.7759/cureus.42987. Available from here
7. Cleveland Clinic. Craniotomy [Internet]. Cleveland, OH: Cleveland Clinic; Last updated 2023 April 13. [Cited 2025 Feb 09]. Available from here
8. Olson DA. Head injury medication. Medication summary. [Internet]. Medscape. [Updated 2024 Dec. 24]; Cited 2025 Feb 09. Available from here
9. Verill DS. Classification and Complications of Traumatic Brain Injury. Medical complications. [Internet]. Medscape. [Updated 2024 March 19]; Cited 2025 Feb 09. Available from here
Published: May 16, 2025
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