Dural Haematomas Flashcards
What is an extradural haematoma?
An extradural haematoma is a bleed into the ‘potential’ space between the dura meningeal layer and the inner surface of the skull.
How does dural haematoma happen?
It occurs due to low impact trauma to the side of the head causing laceration of middle meningeal artery running deep to the pterion.
This results from the increasing blood volume from a ruptured vessel, typically the middle meningeal, causing the dura to be peeled away from the inner layer of the skull.
Characteristic sign of a dural haematoma?
On CT/MRI the characteristic sign of an extradural haematoma is a biconvex, high density area or “lemon” sign.
Dural haematoma symptoms
– Initial headache and potential loss of consciousness
– Gives a lucid interval (hours to days) as haematoma grows
– Late rapid deterioration with severe headache, decreasing GCS, seizures
– Ipsilateral pupil dilates, bilateral leg weakness + irregular breathing
– Raised ICP gives Cushing’s triad –> bradycardia, hypertension + deep breathing
– Coma and death by respiratory arrest (compression of medulla)
Dural Haematomas tests
Non-contrast CT is first choice – shows blood which does not cross suture lines
Dural haematoma management
– Surgery –> craniotomy at haematoma to relieve pressure + ligation of blood vessels
– Medication –> Diuretics (reduce ICP) and prophylactic antibiotics
What is subdural haematoma?
This is a collection of blood between the dural and arachnoid mater of the brain.
How long do subdural haematomas last?
Can be acute (<3 days, associated with high impact trauma) or chronic (>21 days, in elderly and alcoholics)
What causes subdural haematomas?
– Can be due to high impact trauma to head, rupturing bridging veins in dural venous sinuses
– Also due to metastases + rupture of aneurysms
Subdural Haematomas risk factors
Elderly (brain atrophy makes bridging veins vulnerable)
Alcoholism
Anticoagulation
Subdural haematoma symptoms
– Chronic headache or new onset headache
– Fluctuating level of consciousness is key
– Confusion + altered mental state (irritability)
– Localizing neurological signs occur late –> unequal pupils, loss of smell, loss of hearing
Subdural haematoma tests
1st choice is non-contrast CT – shows banana shape (does cross suture lines)
