Nontraumatic epidural haemorrhage
ICD-10 I62.1 · ICD-11 8B03

Treatment of Nontraumatic Epidural Haemorrhage with Preserved Level of Consciousness and Absence of Focal Neurological Deficit

Not every intracranial epidural haemorrhage requires immediate surgery. In a specific subset of patients who meet well-defined clinical and imaging criteria, a conservative strategy is indicated — provided close surveillance is maintained throughout.

Clinical Scenario

This protocol applies when all of the following criteria are present:

Approach (Partial Summary)

Management centres on constant clinical observation combined with CT monitoring, with tranexamic acid included as part of the conservative approach for bleeding control.

The complete structured regimen — including monitoring intervals, pharmacological specifics, and criteria for escalation to surgery — is available in the full protocol below.

Treatment Goal Prevention of hematoma volume expansion, tracked by serial CT. When expansion does occur, it begins approximately eight hours after trauma and completes within 36 hours.
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References

DOI: 10.1055/s-0044-1796652

Conservative treatment is indicated in patients with a preserved level of consciousness, without focal neurological deficit, absence of associated intracranial lesion, and CT showing IEH volume below <30 ml, thickness below 15 mm, and midline shift below 5 mm six hours or more after trauma, but with constant clinical observation and CT monitoring; in case of neurological decompensation, immediate surgery is indicated.

Samadi-Motlagh et al.29 used tranexamic acid in selected IEH patients for conservative treatment and observed a decrease in hematoma volume expansion compared to the control group that did not use the medication, concluding that tranexamic acid plays an important role in bleeding control in IEH patients and improves their prognosis.

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