Extra dural haematoma Flashcards
A patient is tackled and strikes his head, he loses consciousness temporarily, but wakes up and recovers. 1 hour later he becomes confused and progressively becomes less responsive… differential diagnosis???
TIA, extra or subdural haematoma, subarachnoid haemorrhage, traumatic brain injury, intracranial abscess
patient has a GCS of 8, what is your next step in assessing them
ABCDE
patients with a GCS less than 8 should be? why is this
intubated - they are considered at risk
may lack protective airway reflexes and require a definitive airway
scan for extradural haematoma
non -contrast CT
What will you often seen on a CT
left or ride sided extradural haematoma with a midline shift and effacement of ventricles, may also see a bone fracture
what shape to extradural haematomas give and why
biconvex/lentiform shape
they are extra-axial collections
what doe extra-axial collections mean
they are external to the brain parenchyma and collect between the suture lines of the cranium
Where do EDH form
between the skull and dura matter
what is the outer most layer of the meninges
the dura - thick tough and inextensible - lies directly underneath the bones of the skull
the dura consists of 2 connective tissue sheets, what are they
periosteal - lines inner surface of cranium bones
meningeal - lies deep to periosteal layer in the cranial cavity
what vessel is commonly involved in an extradural haematoma
middle meningeal artery - tears often occur during trauma to the lateral aspect of the skull
the middle meningeal artery is a branch of what
the maxillary artery which is a terminal branch of the ECA
most of the time, EDH are associated with
skull fractures
what part of the skull does the MMA lie over
pterion - joins frontal, temporal, parietal and sphenoid at junction
Difficult to treat EDH often from injury to what
diploic veins or venous sinuses
How do EDH’s normally present?
initial loss of consciousness following trauma, complete transient recovery (lucid interval) - followed by rapid neurological deterioration
EDH’s are often a neurosurgical emergency - why is this
arterial bleeding results in a rapid accumulation of blood in the extradural space.
The enlarging haematoma leads to an elevation in the ICP.
Progression to brain herniation can occur rapidly
what herniation syndromes can occur?
uncal and brainstem
What does uncal herniation result in
fixed dilated pupil from IIIn compression
what does brain stem herniation result in
hypertension, bradycardia and irregular breathing (cushing’s reflex from raised ICP)
what factors determine the outcome of EDH
GCS, age, pupillary abnormalities, associated intracranial lesions, ICP
how do you treat EDH, non-surgical and surgical
non- serial CT’s and close neuro obsservation
surgical - burr holes and craniotomy to evacuate the clot
surgical criteria?
volume of EDH >30
midline shift >5mm
haematoma thickness >15mm
complications from a craniotomy
intra and post -operative bleeding, seizure, hydrocephalus, meningitis, coma, death
