Extradural haemorrhage

Question 1

An extradural haemorrhage is caused by…

Answer 1

Trauma to middle meningeal artery

Question 2

Which bone is fragile and if damaged, can also cause trauma on the middle meningeal artery, possibly causing an extradural haemorrhage?

Answer 2

Lateral pterygoid bone

Question 3

True or false: there is an increased risk of extradural haemorrhage with age?

Answer 3

False
The dura becomes more firmly adhered to the skull so decreased risk

Question 4

What age group are most likely to present with extradural haemorrhage?

Answer 4

20-30s

Question 5

What are risk factors for extradural haemorrhage?

Answer 5

Head trauma

Question 6

What are symptoms of extradural haemorrhage?

Answer 6

Initial event is followed by a lucid interval (feeling fine). This can last hours to weeks.
Then rapid deterioration due to raised ICP

Decreased Glasgow Coma Scale
Increased ICP signs (Cushing’s triad and papillodema)

Question 7

Why does the ICP raise with an extradural haemorrhage?

Answer 7

Lucid interval old blood clots and is haemolysed.
This haemolysis takes up water (is osmotically active) so increases the volume in the skill, raising the ICP.

Question 8

What is a complication of extradural haemorrhage?

Answer 8

Death from respiratory arrest.

Cerebellar tonsillar herniation and coning of brain (compression of medulla) due to untreated ICP

Question 9

How do you diagnose an extradural haemorrhage?

Answer 9

NC CT Head: Lens shaped hyperdense bleed
Is confined to suture lines
Midline shift

Question 10

How do you treat an extradural haemorrhage?

Answer 10

Urgent surgery
IV mannitol to reduce ICP