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Z - Neuro and Stroke where elliot fucked it > Extradural Haematoma > Flashcards

Extradural Haematoma Flashcards

1
Q

How can intracranial haemorrhages be classified?

A
  • Intra-axial

- Extra-axial

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2
Q

What is an intra-axial haemorrhage?

A

Within the brain parenchyma

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3
Q

What is an extra-axial haemorrhage?

A

Outside the brain

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4
Q

What type of intracranial haemorrhage is an extradural haematoma?

A

Extra-axial

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5
Q

What is an extradural haematoma?

A

An extra-axial bleed occurring between the dura and skull bone

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6
Q

What % of head injuries in ED are extradural haematomas?

A

2%

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7
Q

Why are extradural haematomas significant?

A

They are associated with significant morbidity and mortality especially with advancing age

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8
Q

When do extradural haematomas typically occur?

A

Following blunt force head trauma resulting in a linear skull fracture

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9
Q

Fractures of which part of the skull most commonly result in extradural haematoma?

A

Parieto-temporal region

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10
Q

What events most commonly precipitate extradural haematoma?

A

RTAs, assault, falls

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11
Q

What is the most common source of bleeding in an extradural haematoma?

A

Middle meningeal artery

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12
Q

What % of extradural haematomas involve bleeding from the middle meningeal artery?

A

85%

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13
Q

Fractures in what region of the skull most commonly lead to damage of the middle meningeal artery?

A

Pterion

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14
Q

What branch of the middle meningeal artery lies below the pterion?

A

Anterior branch

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15
Q

What are some less common causes of extradural haematoma?

A
  • Diploic vein bleeds
  • Vascular malformations
  • Infective pathology
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16
Q

What are the risk factors for extradural haematoma?

A
  • Male gender
  • 20-30
  • High risk behaviours
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17
Q

What are the high risk behaviours for extradural haematoma?

A
  • Crime/violent activities

- Contact sports

18
Q

What is usually a key feature of an extradural haematoma history?

A

Trauma or fall

19
Q

What is the usual progression of an extradural haematoma presentation?

A

Loss of consciousness at time of injury followed by a lucid period before further deterioration

20
Q

What are some additional symptoms of extradural haematoma?

A
  • Headache
  • Nausea and vomiting
  • Progressive drowsiness
21
Q

What may patients with extradural haematoma have on examination?

A
  • Low GCS
  • Localising neurological symptoms
  • Clinical features of brain herniation or raised ICP
22
Q

What can extradural haematoma lead to if untreated?

A

Coma and death

23
Q

What are the initial investigations for extradural haematoma?

A
  • Urgent bloods

- CT head

24
Q

What bloods should be taken urgently in extradural haematoma?

A
  • FBC
  • U&E
  • CRP
  • Clotting
  • G&S
25
What will CT head classically show in extradural haematoma?
Hyperdense (white) biconvex (lemon) lesions
26
What do some CT head scans show in extradural haematoma?
Associated skull fracture
27
What investigations may be required after work-up in extradural haematoma?
Further imaging
28
How should most extradural haematomas be managed?
As per the ATLS protocol
29
What is the ATLS protocol?
Advanced Trauma Life Support protocol
30
Input from what team is require after diagnosis of extradural haematoma?
Urgent neurosurgical input
31
When are extradural haematomas managed surgically regardless of other factors?
If >30cm^3
32
When can extradural haematomas be managed conservatively?
If <30cm^3 with low thickness, minimal midline shift and GCS >8 without focal neurological deficits
33
What does conservative management of extradural haematoma typically involve?
Serial CT imaging and close neurosurgical observation
34
How can raised ICP be managed conservatively in extradural haematoma?
- Osmotic diuretics e.g. IV mannitol | - Hypertonic saline
35
What are the surgical options for managing extradural haematoma?
- Craniotomy | - Burr holes
36
How can bleeding sources be controlled in extradural haematoma?
Ligation or cauterisation if necessary
37
How should patients with a extradural haematoma be cared for after surgery?
- Observed on Neuro-critical care or HDU with close neuro-obs - Routine post-op CT scans to ensure adequate clot removal - Neurorehabilitation
38
What are the potential complications of extradural haematoma?
- Neurological deficits (temporary or permanent) - Post-traumatic seizures - Post-concussion syndrome
39
What causes post-traumatic seizures?
Cortical damage
40
When can post-traumatic seizures develop?
1-3 months after injury
41
What are the features of post-concussion syndrome?
- Headaches - Dizziness - Vertigo - Restlessness - Emotional lability - Inability to concentrate - Fatigue
42
What is the overall mortality of extradural haematoma?
30%

Z - Neuro and Stroke where elliot fucked it (3 decks)

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