Extradural (epidural) haematoma Flashcards
What interval is common in extradural bleeds?
Lucid interval
Where does the blood accumulate in an extradural bleed?
Between the bone and dura
What are the causes of an extradural bleed?
Traumatic skull fracture - temporal or parietal - laceration of the middle meningeal artery and vein
Trauma to temple lateral to the eye
Tear in dural venous sinus
How long will the lucid interval last?
Few hours to few days
What are the clinical signs and symptoms of an extradural bleed?
Lucid interval Decreasing GCS due to increasing ICP Increasingly severe headache Vomiting Confusion Seizures Hemiparesis Brisk reflexes with upgoing plantars Ipsilateral pupil dilation Coma
What are some late signs of extradural haematoma
Increased BP Bradycardia Respiratory arrest Death Bilateral leg weakness Deep and irregular breathing (brainstem compression)
Which test is contraindicated in extradural haematomas?
LP
Which investigations would you do to diagnose extradural haematoma?
CT - biconvex/lens shaped - blood is more rounded
Skull Xray - may show fractures over the course of the middle meningeal artery
Why does an extradural haematoma form a biconvex shape?
Tough dural attachments to the skull keep it more localized
Which artery is implicated in extradural bleeds?
Middle meningeal artery
Describe the management of extradural haematoma
Stabilise and transfer urgently to neurosurgical unit for clot evacuation and ligation of blood vessels
Care of the airway in an unconscious patient and measures to decreased ICP often require intubation and ventilation with mannitol IVI
Describe the prognosis of an extradural haematoma
Excellent if diagnosis and operation early
Poor if coma, pupil abnormalities or decerebrate rigidity are present pre-op
