During a high school reunion in your backyard, you and your friends decided to play baseball. By accident, the ball hit one of your friend’s head quite hard and he became dizzy for a while. After a while, he recovered and everyone gathered around for a conversation. Everyone laughed and cried as topics from the past and the future were discussed, from high school years to tomorrow’s ambition. Just as everyone is about to leave, that same friend suddenly collapsed, struggled to breathe and not long after, died. He was fine a minute ago, what happened?
What’s going on?
This period of being seemingly healthy after sustaining a blow or an injury to the head, before eventually deteriorating is known as the ‘Lucid Interval’ and it is a classical symptom of Epidural Hematoma (a type of intra-cranial bleed). Epidural hematoma simply refers to the collection of blood from bleeding that occurs between the outermost layer of the covering of the brain (dura mater) and the skull and it is usually due to the laceration of the middle meningeal artery. Epidural hematoma is usually caused by traumatic hit to the head most commonly from motor-vehicle accidents, fall or assault but there can also be instances when it happens spontaneously in about 10% of the cases.
How does a Lucid Interval happen?
After the blow or the injury to the head, patient may experience a period of dizziness or unconsciousness as a result of the initial concussion. Since the laceration involves the artery, which carries blood under high pressure, blood begins to pool quickly between the meninges and the skull, reaching from 25 cm cubic to 75 cm cubic in just 6 to 8 hours. It is in this time, the person is said to be experiencing lucid interval, feeling fine and resuming normal activity, unbeknown to him that inside the skull, blood is leaking and pooling with each passing minute. The growing pool of blood increases the pressure in the brain, stripping the dura from the skull and compresses the brain from within.
Once the damage has involved the brainstem, consciousness and respiratory control gradually decline before coming to a complete stop. It is worth mentioning as well that bleeding can also come from the vein and due to the difference between arterial and venous pressure, build up of blood and the effect of lucid interval is very rarely observed in the case of bleeding from the vein.
How is it treated?
Epidural hematoma is a surgical emergency. This mean that it needs surgical intervention immediately to remove the pooling of blood as delay in intervention can almost indefinitely cause death or permanent brain damage. If you sustained blow to the head or suspected to have traumatic brain injury, get urgent medical attention to assess the severity of the condition.
How common is it?
For epidural hematoma, about 2% of head injuries and 15 percent of fatal head injuries involves an epidural hematoma and it usually occurs in cases involving teenagers and young adults, with males being affected more than females. It gets more and more uncommon as the person gets older because the dura mater sticks more to the skull as the person ages.
In term of Lucid Interval, it is estimated that only 20 to 50% of patients with epidural hematoma experience lucid interval. While that may sound like a good thing, in reality, prognosis (forecast of the likely outcome of a situation) is better if there was a lucid interval than if the person was comatose from the time of injury.
Injury to the head involving epidural hematoma is not common but it has been responsible for the death of a few notable figures such as the very founder of the Atkins diet himself, Dr. Robert Atkins, who, on April 17th 2003, slipped on the ice while walking to work, hitting his head in the process before bleeding around the brain ensued. He lost consciousness on the way to the hospital and after 2 weeks in intensive care, he passed away and was reported to die from “blunt impact injury of the head with epidural hematoma”.
Actress and wife to Liam Neeson, Natasha Richardson also died due to epidural hematoma after she fell while taking a beginner skiing lesson in Quebec, Canada. While she did experience lucid interval, by the time she reached medical care, the hematoma had already caused significant damage and she died two days later.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Review Date: March 12, 2019 | Last Modified: November 15, 2019