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A - MSRA Neuro and Stroke [12] > [4] Extradural Haematoma > Flashcards

[4] Extradural Haematoma Flashcards

1
Q

How can intracranial haemorrhages be classified?

A
  • Intra-axial

- Extra-axial

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2
Q

What is an intra-axial haemorrhage?

A

Within the brain parenchyma

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3
Q

What is an extra-axial haemorrhage?

A

Outside the brain

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4
Q

What type of intracranial haemorrhage is an extradural haematoma?

A

Extra-axial

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5
Q

What is an extradural haematoma?

A

An extra-axial bleed occurring between the dura and skull bone

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6
Q

What % of head injuries in ED are extradural haematomas?

A

2%

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7
Q

Why are extradural haematomas significant?

A

They are associated with significant morbidity and mortality especially with advancing age

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8
Q

When do extradural haematomas typically occur?

A

Following blunt force head trauma resulting in a linear skull fracture

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9
Q

Fractures of which part of the skull most commonly result in extradural haematoma?

A

Parieto-temporal region

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10
Q

What events most commonly precipitate extradural haematoma?

A

RTAs, assault, falls

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11
Q

What is the most common source of bleeding in an extradural haematoma?

A

Middle meningeal artery

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12
Q

What % of extradural haematomas involve bleeding from the middle meningeal artery?

A

85%

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13
Q

Fractures in what region of the skull most commonly lead to damage of the middle meningeal artery?

A

Pterion

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14
Q

What branch of the middle meningeal artery lies below the pterion?

A

Anterior branch

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15
Q

What are some less common causes of extradural haematoma?

A
  • Diploic vein bleeds
  • Vascular malformations
  • Infective pathology
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16
Q

What are the risk factors for extradural haematoma?

A
  • Male gender
  • 20-30
  • High risk behaviours
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17
Q

What are the high risk behaviours for extradural haematoma?

A
  • Crime/violent activities

- Contact sports

18
Q

What is usually a key feature of an extradural haematoma history?

A

Trauma or fall

19
Q

What is the usual progression of an extradural haematoma presentation?

A

Loss of consciousness at time of injury followed by a lucid period before further deterioration

20
Q

What are some additional symptoms of extradural haematoma?

A
  • Headache
  • Nausea and vomiting
  • Progressive drowsiness
21
Q

What may patients with extradural haematoma have on examination?

A
  • Low GCS
  • Localising neurological symptoms
  • Clinical features of brain herniation or raised ICP
22
Q

What can extradural haematoma lead to if untreated?

A

Coma and death

23
Q

What are the initial investigations for extradural haematoma?

A
  • Urgent bloods

- CT head

24
Q

What bloods should be taken urgently in extradural haematoma?

A
  • FBC
  • U&E
  • CRP
  • Clotting
  • G&S
25
Q

What will CT head classically show in extradural haematoma?

A

Hyperdense (white) biconvex (lemon) lesions

26
Q

What do some CT head scans show in extradural haematoma?

A

Associated skull fracture

27
Q

What investigations may be required after work-up in extradural haematoma?

A

Further imaging

28
Q

How should most extradural haematomas be managed?

A

As per the ATLS protocol

29
Q

What is the ATLS protocol?

A

Advanced Trauma Life Support protocol

30
Q

Input from what team is require after diagnosis of extradural haematoma?

A

Urgent neurosurgical input

31
Q

When are extradural haematomas managed surgically regardless of other factors?

A

If >30cm^3

32
Q

When can extradural haematomas be managed conservatively?

A

If <30cm^3 with low thickness, minimal midline shift and GCS >8 without focal neurological deficits

33
Q

What does conservative management of extradural haematoma typically involve?

A

Serial CT imaging and close neurosurgical observation

34
Q

How can raised ICP be managed conservatively in extradural haematoma?

A
  • Osmotic diuretics e.g. IV mannitol

- Hypertonic saline

35
Q

What are the surgical options for managing extradural haematoma?

A
  • Craniotomy

- Burr holes

36
Q

How can bleeding sources be controlled in extradural haematoma?

A

Ligation or cauterisation if necessary

37
Q

How should patients with a extradural haematoma be cared for after surgery?

A
  • Observed on Neuro-critical care or HDU with close neuro-obs
  • Routine post-op CT scans to ensure adequate clot removal
  • Neurorehabilitation
38
Q

What are the potential complications of extradural haematoma?

A
  • Neurological deficits (temporary or permanent)
  • Post-traumatic seizures
  • Post-concussion syndrome
39
Q

What causes post-traumatic seizures?

A

Cortical damage

40
Q

When can post-traumatic seizures develop?

A

1-3 months after injury

41
Q

What are the features of post-concussion syndrome?

A
  • Headaches
  • Dizziness
  • Vertigo
  • Restlessness
  • Emotional lability
  • Inability to concentrate
  • Fatigue
42
Q

What is the overall mortality of extradural haematoma?

A - MSRA Neuro and Stroke [12] (33 decks)

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