Extradural/Epidural Haemorrhage

Question 1

Define:

Answer 1

Bleeding and accumulation of blood in the extradural space (the space between the dura and the skull)

Question 2

Aetiology:

Answer 2

TRAUMA - usually to the pterion that will lead to rupture of the middle meningeal artery and vein

May also be due to tears in the dural venous sinus

Question 3

Risk factors:

Answer 3

Bleeding tendencies:

• Anticoagulation
• Haemophilia etc

Question 4

Epidemiology:

Answer 4

20/100,000 incidence in the UK

10% of severe head injuries

Mainly in young adults

Question 5

Symptoms:

Answer 5

Head trauma followed by loss of consciousness/drowsiness

This is followed by a lucid period

Deterioration of the GCS due to the increasing ICP

Severe headaches, vomiting, confusion, fits +/- hemiparesis with brisk reflexes and up-going plantars

If there is continued bleeding then ipsilateral dilated pupils. coma, bilateral limb weakness and laboured breathing

Question 6

Signs:

Answer 6

Scalp trauma/injury

Deteriorating GCS

Raised ICP signs:
-Dilated unresponsive pupils on the side of the injury

Cushing’s reflex (due to the compression on the brainstem)

• hypertension
• Bradycardia
• Irregular breathing

Question 7

Investigations:

Answer 7

Urgent CT scan to check for haematoma (it may show a midline shift) –> CONVEX SHAPE

Look for features of raised ICP