Extradural Haemorrhage

Question 1

Define extradural haemorrhage.

Answer 1

A contusion resulting in bleeding into the extradural space. This results in raised intracranial pressure and possibly compression of the brain resulting in neurological disorders and potential death.

Question 2

Explain the aetiology/risk factors of extradural haemorrhage.

Answer 2

This is usually caused by trauma with a lot of force.

Question 3

Summarise the epidemiology of extradural haemorrhage.

Answer 3

Intracranial epidural hematoma occurs in approximately 2% of patients with head injuries and 5–15% of patients with fatal head injuries.

Question 4

Recognise the signs of extradural haemorrhage on physical examination. Recognise the presenting symptoms of extradural haemorrhage.

Answer 4

TRIPHASIC
There is loss of consciousness followed by a LUCID INTERVAL before the patient’s condition declines again.
LOC is followed by headache, progressive obtundation, and hemiparesis. Bleeding may eventually cause a “blown pupil” secondary to uncal herniation. The “blown pupil” will be ipsilateral and the hemiparesis will be contralateral.

Question 5

Identify appropriate investigations for extradural haemorrhage and interpret the results.

Answer 5

CT scan - Will show characteristic bi-convex mass within the skull if there is an EDH is present (“lemon-shaped” as opposed to the typical “banana-shape” of subdural haemorrhages).
MRI - Takes longer so is not suitable for first line but can be useful after surgery in order to determine if there is ischaemia of the brain.

Question 6

Generate a management plan for extradural haemorrhage.

Answer 6

Craniotomy and hematoma evacuation.