Why some patients may be more prone to epidural hematoma than the normal population?
End-stage renal disease and uremia are risk factors for epidural hematoma. Moreover, this patient demonstrates the systemic ramifications of advanced renal disease in multi-organ dysfunction, including the coagulation system. Even though the patient may have a normal platelet count, uremia causes a qualitative platelet dysfunction. In fact, advanced renal disease disrupts normal platelet activation, aggregation, and adherence. The etiology of altered hemostasis is multifactorial, but includes a release in platelet-inhibitory factors as well as a disturbance in the platelet-vessel wall. Early studies had made the observation that uremic platelets in normal plasma function normally. Consequently, uremic plasma mixed with normal platelets triggered platelet dysfunction. Thus, the hypothesis was made that platelet-inhibitory factors in the plasma of uremic patients led to impaired platelet function. However, in vitro studies could not replicate this effect with the known uremic toxins unti
