epidural haematoma Flashcards
What does intracranial epidural hematoma (EDH) refer to?
Bleeding between the dura mater and the calvarium
EDH is often associated with head trauma.
What is the most common cause of EDH?
Traumatic head injury resulting from a skull fracture that ruptures the middle meningeal artery
The middle meningeal artery is located near the skull and dura mater.
In which age group is EDH more common?
Individuals 20–30 years of age
This is because the dura mater is not yet densely adherent to the calvarium at this age.
What is the classic manifestation of EDH?
Initial loss of consciousness followed by a lucid interval and then rapid neurological decline
The lucid interval is a key feature in the presentation of EDH.
What are two manifestations of transtentorial uncal herniation?
Ipsilateral dilated pupil (anisocoria) and contralateral hemiparesis
These indicate imminent neurological decline.
What should take precedence over diagnostic tests in EDH management?
Neuroprotective measures to prevent secondary brain injury
This is crucial in the acute setting.
How is the diagnosis of EDH confirmed?
Noncontrast CT head
EDH appears as a biconvex, hyperdense lesion on the scan.
Where is EDH typically located on a CT scan?
Temporal or temporoparietal region
The location is important for surgical planning.
What are the indications for surgical decompression with craniotomy in EDH?
Large EDH, GCS ≤ 8, and/or evidence of neurological deterioration
These criteria help determine the need for urgent intervention.
How can small, asymptomatic EDH be managed?
Conservatively with close observation and serial CT scanning
This approach is suitable for patients with GCS > 8.
What factors influence the prognosis of EDH?
GCS at presentation, size of the EDH, and time from brain herniation onset to surgery
Timely intervention is crucial for better outcomes.
What percentage of patients with EDH experience a lucid interval?
20–50%
What is the classic presentation of EDH?
Initial loss of consciousness, temporary recovery, renewed decline in neurological status
What may cause renewed decline in neurological status in EDH patients?
Hematoma expansion and mass effect
What are common signs of increased intracranial pressure (ICP)?
- Headache
- increased systolic blood pressure
- bradycardia
- irregular breathing
What is the most common pupillary abnormality seen with EDH?
Anisocoria with ipsilateral mydriasis
What are signs of associated skull fractures?
- Scalp hematoma
- Liquorrhea
- CSF rhinorrhea
- Otorrhea
- Battle sign
- Raccoon eyes
What is the first-line imaging in patients with suspected acute EDH?
CT head without IV contrast
What are the characteristic findings of an epidural hematoma on a CT scan?
Biconvex (lenticular shaped), sharply demarcated extraaxial lesion, typically hyperdense in appearance
What is an epidural hematoma limited by on a CT scan?
Limited by suture lines
Suture lines are the fibrous joints between the bones of the skull.
Where are common locations for arterial and venous epidural hematomas?
Arterial EDH: temporal or temporoparietal region; Venous EDH: posterior cranial fossa
Arterial EDHs are often associated with skull fractures.
What evidence might be present on a CT scan for a patient with an epidural hematoma?
Evidence of skull fracture, if present
Skull fractures are often associated with the presence of an epidural hematoma.
What should be done if there is neurological deterioration in a patient with suspected delayed EDH?
A repeat CT should be performed even if the initial CT scan was normal
Delayed EDH can occur, and small lesions can expand quickly.
True or False: The initial CT scan may be normal in patients with delayed EDH.
True
This is why monitoring and follow-up imaging are crucial.
