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Year Two - Neurology System > Extradural Haemorrhage > Flashcards

Extradural Haemorrhage Flashcards

1
Q

What is an extradural haemorrhage (EDH)?

A

It is an intracranial haemorrhage within the extradural space, which is located between the dura mater and the inner surface of the skull

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2
Q

Describe the pathophysiological consequence of extradural haemorrhages

A

There is compression of local brain structures and a rise in intracranial pressure

If intracranial pressure continues to rise, midline shift and tentorial herniation may occur – leading to brainstem death

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3
Q

Which artery is most commonly associated with extradural haemorrhages?

A

Midline meningeal artery (MMA)

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4
Q

What is the most common cause of a middle meningeal artery rupture?

A

Low impact skull trauma in the temporoparietal region, specifically affecting the pterion

In most cases, a temporal skull fracture is associated

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5
Q

What is the pterion?

A

It is the anatomical landmark where the parietal, frontal, sphenoid and temporal bones fuse

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6
Q

Which artery underlies the pterion?

A

Middle meningeal artery

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7
Q

What are the two risk factors associated with an extradural haemorrhage?

A

Male Gender

Young Age, 20 – 30 Years Old

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8
Q

What are the eleven clinical features of extradural haemorrhage?

A

Immediate Consciousness Loss > Injury

Lucid Interval

Progressive Decreasing Consciousness Level

Headache

Confusion

Hemiparesis

Paraesthesia

Oculomotor Nerve Palsy

Hyperreflexia

Babinski’s Sign

Cushing’s Reflex

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9
Q

How long following the initial head injury do individuals experience a decreasing conscious level? Why?

A

It usually takes several hours

It is related to the effects of increased intracranial pressure due to the expanding haematoma and brain herniation

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10
Q

What is the clinical feature associated with oculomotor nerve palsy?

A

Fixed dilation of the ipsilateral pupil

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11
Q

What is Babinski’s sign?

A

Upgoing plantar reflex

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12
Q

What is Cushing’s reflex?

A

It is the physiological response to raised ICP, in order to improve perfusion of the body

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13
Q

What are the triad of clinical features associated with Cushing’s reflex?

A

Hypertension

Bradycardia

Irregular breathing pattern

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14
Q

What are the two investigations used to diagnose extradural haemorrhages?

A

Skull X-Ray

CT Scan

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15
Q

How are skull x-rays used to investigate extradural haemorrhages?

A

They are not used in the investigation of extradural haemorrhages

However, it is important to note that in cases where a skull fracture is identified on a skull x-ray, a CT scan should be performed urgently to assess for evidence of an extradural haemorrhage

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16
Q

What is the gold standard investigation used to diagnose extradural haemorrhages?

A

CT scan

17
Q

What are the four features of extradural haemorrhages on CT scans?

A

Bi-Convex Lemon Hyperdense Mass

Mass Limitation To Suture Lines of Skull

Midline Shift

Brainstem Herniation

18
Q

Why do extradural haemorrhages appear lemon-shaped on CT scans?

A

This is due to the haematoma being forced to expand medially due to inability to expand past the suture lines of the skull

19
Q

What are the five initial management options of extradural haemorrhages?

A

ABCDE Approach

Coagulation Correction

Prophylactic Antibiotics

Anticonvulsant Medications

Intracranial Pressure Reduction Agents

20
Q

What coagulation correction is recommended in extradural haemorrhages?

A

In cases where individuals are on anticoagulants, they should receive reversal agents to prevent further bleeding

OR

In cases where individuals have coaguloapathy, haematology advice is required to determine whether transfusions are required

21
Q

Why are prophylactic antibiotics used to manage extradural haemorrhages?

A

They reduce the risk of intracranial infection

22
Q

Why are anticonvulsants used to manage extradural haemorrhages?

A

They reduce the risk of seizure development

23
Q

Name two anticonvulsants used to manage extradural haemorrhages

A

Levitracetam

Phenytoin

24
Q

Name two drugs used to reduce intracranial pressure

A

IV mannitol

Barbiturates

25
Q

When is conservative management of extradural haemorrhages recommended?

A

In cases of small haemorrhages with no neurological deficits

26
Q

What is the conservative management option of extradural haemorrhages?

A

Cautious clinical and radiological observation

27
Q

What are the two surgical management options of extradural haemorrhages?

A

Burr Hole Craniotomy

Craniotomy

28
Q

What is burr hole craniotomy?

A

It involves formation of a small hole within the skull

This enables insertion of a suction tube to evacuate the haematoma

29
Q

What is the first line surgical management option of extradural haemorrhages?

A

Craniotomy

30
Q

What is craniotomy?

A

It involves surgical removal of a skull section, with evacuation of the haematoma and ligation of the ruptured blood vessel

31
Q

What are the five complications of extradural haemorrhages?

A

Intracranial Infection

Cerebral Ischaemia

Seizures

Hydrocephalus

Brainstem Injury

Year Two - Neurology System (25 decks)

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