Extradural Haemorrhage

Question 1

Extradural Haemorrhage

____lateral dilated pupil and ____lateral hemiparesis

choose ipsi/contra for both

Answer 1

ipsilateral dilated pupil and contralateral hemiparesis

Question 2

Extradural Haemorrhage

An extradural haematoma most commonly occurs as a result of ____ in the ____ part of the skull and causes a collection of blood between the dura mater and the skull.

Answer 2

An extradural haematoma most commonly occurs as a result of trauma in the temporoparietal part of the skull and causes a collection of blood between the dura mater and the skull.

Question 3

Extradural Haemorrhage

In the majority of cases, what vessel is the one that ruptures?

Answer 3

the middle meningeal artery

• can also happen if the middle meningeal vein or dural sinuses rupture.

Question 4

Extradural Haemorrhage

Many patients make a full recovery, but what complications can this kind of brain injury develop into?

5

Answer 4

• infection associated with the skull fracture
• cognitive impairment (as a result of increased intracranial pressure for a period of time)
• development of epilepsy
• hemiparesis
• injury to the brainstem.

Question 5

Extradural Haemorrhage

What are some clinical features?

Answer 5

• loss of consciousness/confusion/tiredness at time of injury
• improvement (lucid period, minutes to hours) before symptoms develop
• as ICP rises, so do symptoms such as headache, nausea and vomitting
• if not treated this can cause hemiparesis, seizures, coma and death

Question 6

Extradural Haemorrhage

What are some clinical signs?

Answer 6

• brisk reflexes
• a positive Babinski’s sign
• fixed, dilated pupil on the side of the bleed.

Question 7

Extradural Haemorrhage

If a pt has fixed dilated pupils on the right, what side is the haemorrhage on?

Answer 7

right (ipsilateral)

Question 8

Extradural Haemorrhage

What can a rise in ICP lead to?

Answer 8

brainstem to herniate through the foramen magnum, leading to coning and brainstem death.

Question 9

Extradural Haemorrhage

On a CT head, the extradural haematoma gives a ‘____-shaped’ appearance

Answer 9

lemon

Question 10

Extradural Haemorrhage

What is the best investigation?

Answer 10

CT

Question 11

Extradural Haemorrhage

Once it has been diagnosed, what will neurosurgery do for management?

Answer 11

• decompress the skull
• evacuate the haematoma
• stop any more bleeding

This is usually done via a burr hole drilled into the skull, but sometimes a craniectomy is needed to access the bleeding vessels.

Question 12

Extradural Haemorrhage

A poor prognosis is associated with a low ____ on arrival, a ____+____ pupil or ____ posturing.

Answer 12

a poorer prognosis is associated with a low GCS on arrival, a fixed, dilated pupil or decerebrate posturing.

Question 13

Extradural Haemorrhage

Medical management includes the use of drugs such as ____ and ____ to decrease intracranial pressure.

Answer 13

Medical management includes the use of drugs such as mannitol and barbiturates to decrease intracranial pressure.

Question 14

Extradural Haemorrhage

If there has been an open skull fracture, ____ are given to prevent infections such as ____.

Answer 14

If there has been an open skull fracture, prophylactic antibiotics are given to prevent infections such as meningitis.