Extradural haemorrhage

Question 1

Define an extradural haemorrhage

Answer 1

Collection of blood between the dura mater and the bone usually cause by head injury

Question 2

When should you suspect an extradural haemorrhage?

Answer 2

after a traumatic head injury with low conscious levels or slow to improve or lucid interval

Question 3

What is the cause of extradural haemorrhage and what does it lead to?

Answer 3

Most commonly due to traumatic head injury resulting in fracture of the temporal or parietal bone causing the rupture of the middle meningeal artery

Question 4

Who is extradural haemorrhages usually seen in?

Answer 4

Usually occurs in young adults

Question 5

What are the symptoms of extradural haemorrhage?

Answer 5

• Head injury
• Brief LOC or drowsiness
• Lucid interval – haemotoma is still small, can last hours to a few days
• Followed by rapid decline, severe headache, vomiting, confusion, seizures, raised ICP

Question 6

What is the differential diagnosis of extradural haemorrhage?

Answer 6

• SAH
• Subdural
• Meningitis

Question 7

How do you diagnose extradural haemorrhage?

Answer 7

CT head – Gold standard

Shows hyperdense biconcave region that is adjacent to the
skull

Question 8

What is the treatment for extradural haemorrhage?

Answer 8

• ABCDE assessment
• IV Mannitol - to reduce ICP
• Neurosurgery – Clot evacuation, ligation of middle meningeal artery
• May need intubation and ventilation

Question 9

How do you remember the shape of extradural haemorrhage on CT?

Answer 9

EPIdural –> pie –> lemon shaped

Question 10

Describe the timeline of symptoms in an extradural haemorrhage

Answer 10

1. Initiating event
2. Lucid interval - ‘I feel fine’(hours-days-weeks)
3. Rapid deterioration due to increased ICP - blood clot becomes haemolysed and take up water (increase ICP)