Extradural haemorrhage Flashcards

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1
Q

An extradural (or ‘epidural’) haematoma is a collection of blood that is between the skull and the dura. What is the incidence of a extradural haematoma?

1 - 1 cases per 100,000
2 - 10 cases per 100,000
3 - 100 cases per 100,000
4 - 1000 cases per 100,000

A

1 - 1 cases per 100,000

More common in males
3:1 ratio

Active bleeding = haemorrhage
Collection of blood = haematoma

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2
Q

An extradural (or ‘epidural’) haematoma is a collection of blood that is between the skull and the dura. What age does the incidence peak at?

1 - 20-30
2 - 30-40
3 - 50-60
4 - 60-70

A

1 - 20-30

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3
Q

There are 2 layers of th dura matter, the internal (above subdural space, separating dura and arachnoid matter) and external (attached to skull). Are these 2 layers always in close contact with one another?

A
  • no

Separate at parts to form the meningeal folds

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4
Q

What is contained between the internal and external layer of the dura matter?

1 - CSF
2 - blood vessels
3 - lymph nodes
4 - air

A

2 - blood vessels

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5
Q

All of the following can an cause extradural (or ‘epidural’) haematoma, but which is by far the most common cause?

1 - idiopathic
2 - surgery
3 - head trauma
4 - bleed

A

3 - head trauma

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6
Q

What is the most common site for an extradural (or ‘epidural’) haematoma?

1 - anterior fontanelle
2 - posterior fontanelle
3 - coronal suture
4 - pterion

A

4 - pterion

Location where the frontal, parietal, temporal and sphenoid bones join together

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7
Q

Which blood vessel located below the pterion is most susceptible to rupture during an extradural (or ‘epidural’) haematoma?

1 - occipital artery
2 - meningeal artery
3 - anterior cerebral artery
4 - internal carotid artery

A

2 - meningeal artery

Located above the middle meningeal artery

Pterion region has think skull so more vulnerable

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8
Q

Following a extradural (or ‘epidural’) haematoma, do patients just lose consciousness following the head trauma?

A
  • no

Patients initially lose, briefly regain and then lose consciousness again

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9
Q

The term lucid interval is used in patients experiencing a extradural (or ‘epidural’) haematoma. What does the lucid interval refer to?

1 - patient becomes unconscious but is aware of surroundings
2 - patient is able to feel bleeding associated with a headache
3 - large bleed causing a midline shift
4 - period of time where no symptoms are experienced following trauma

A

4 - period of time following initial trauma where patients lose, briefly regains and then lose consciousness again

They lose consciousness again as the bleed has increased in size

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10
Q

If there is a heavy bleed following an extradural (or ‘epidural’) haematoma, which of the following can occur?

1 - midline shift of the brain
2 - increased intracranial pressure
3 - supratentorial herniation
4 - infratentorial herniation
5 - all of the above

A

5 - all of the above

Supratentorial herniation
- cerebrum is pushed against the skull or the tentorium

Infratentorial herniation
- cerebellum is pushed against the brainstem

Both of the above are lethal

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11
Q

Which of the following clinical findings can support the diagnosis of an extradural (or ‘epidural’) haematoma?

1 - fixed dilated pupil
2 - facial nerve palsy
3 - sensorineural hearing loss
4 - thunderclap headache

A

1 - fixed dilated pupil

Patient will also likely have nausea and vomiting due to concussion

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12
Q

Can an extradural (or ‘epidural’) haematoma cause a thunderclap headache?

A
  • no

Subarachnoid haemorrhage causes a thunderclap headache

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13
Q

When looking at CT brian scans, if you are trying to distinguish if a haemorrhage is subdural or extradural you can remember this:

  • extra-dural haematoma is lentiform like a lemon
  • subdural haematoma is sickle shaped like a banana

Is the image here a extra-dural or subdural haematoma?

A
  • extra-dural haematoma

SHaped like a lemon

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14
Q

In the image attached, is this a subdural or extradural haemorrhage?

A
  • subdural
  • subdural haematoma is sickle shaped like a banana
  • can also see:
    a) With midline shift
    b) Compressed right lateral ventricle
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15
Q

What is the most common treatment for an extradural (or ‘epidural’) haematoma?

1 - craniotomy
2 - transient hyperventilation
3 - IV hypertonic saline
4 - IV mannitol

A

1 - craniotomy

Part of skull removed and blood removed

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16
Q
A