Intravascular Temperature Modulation as an Adjunct to Secondary Brain Injury Prevention in a Patient with an Epidural Hematoma

Marie Lasater, MSN, RN, CCRN, CNRN


J Neurosci Nurs. 2008;40(4):198-200. 

In This Article

Abstract and Introduction

Up to 35% of patients suffering EDHs develop secondary brain injury within days after the initial trauma. Secondary brain injury can profoundly affect a patient's subsequent neurologic recovery and functional status. This case study presents a patient who developed an EDH following severe head trauma with signs and symptoms of secondary brain injury; intravascular temperature modulation was used to treat the secondary injury for a prolonged period of 13 days. The patient showed a complete neurologic recovery with re-turn to work 6 months after her injury.

Epidural hematomas (EDHs) are caused by trauma, usually associated with a skull fracture of the temporoparietal region that causes a tear in the middle meningeal artery. While EDHs are seen in only 1%-4% of patients with head trauma, they account for a disproportionate 10% of fatalities.

With rare exceptions, EDHs are unilateral and supratentorial and are usually found in the temporoparietal area. Reported mortality rates range from 5% to 43%, with poor outcomes most often related to a delay in surgical intervention. Higher mortality rates are also associated with lower Glasgow Coma Scale (GCS) scores, additional intradural lesions, temporal location, larger hematoma volumes, rapid clinical progression, pupil abnormalities, and increased intracranial pressure. Advanced age is also associated with higher mortality, but EDH is uncommon in elderly patients because the dura usually adheres to the inner table of the skull. The following case study describes the course of care, and subsequent recovery, of a patient with a severe EDH with many of the risk factors associated with high mortality rates.