Extradural Haemorrhage

Question 1

Define extradural haemorrhage

Answer 1

Collection of blood between the inner layer of the skull and the outer layer of the dura (periosteal layer)

Question 2

Aetiology and risk factors of extradural haemorrhage

Answer 2

Head trauma → fracture
RF: RTA | fall | assault | contact sports
Temporal bone fracture (thinnest part of the cranial vault) → rupture of the middle meningeal artery
Arterial bleeding → rapid accumulation of blood → stripping of dura from the skull

Question 3

Symptoms and signs of extradural haemorrhag

Answer 3

1. Temporary loss of consciousness
2. lucid interval
3. Progressive deterioration in consciousness

+ Hx head trauma or acute onset headache

Signs: raised ICP:
- Papilloedema
- Dilated, unresponsive pupil
- Decorticate/decerebrate posturing
- Cushing’s reflex: bradycardia + hypertension + irregular breathing

Question 4

Investigations for extradural haemorrhage

Answer 4

Urgent CT head: convex/lens-shaped/lemon-shaped haematoma (hyperdense)
± raised ICP: midline shift | ventricle compression | basal cistern obliteration | sulcal effacement

Question 5

Management for extradural haemorrhage

Answer 5

Advanced Trauma Life support / ABCDE with cervical spine control
Once stabilised → urgent CT scan
Surgery: urgent craniotomy & decompressive evacuation of the haematoma
with diathermy / clipping of the source of bleeding
- ICP monitor may be placed for post-op monitoring
- Close observation and supportive care required (often in ITU)

Question 6

Complications of extradural haemorrhage

Answer 6

Acute:
- Raised intracranial pressure
- Cerebral herniation (uncal)
- CNIII compression
- Death
Long-term:
- Post-traumatic brain injury
- Amnesia
- Cognitive impairment

Question 7

Prognosis for extradural haemorrhage

Answer 7

Mortality rates relate to initial GCS and associated intracerebral injury
Better prognosis is treated early