Extradural haemorrhage

Question 1

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

Answer 1

1 - 1 cases per 100,000

More common in males
3:1 ratio

Active bleeding = haemorrhage
Collection of blood = haematoma

Question 2

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

Answer 2

1 - 20-30

Question 3

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?

Answer 3

• no

Separate at parts to form the meningeal folds

Question 4

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

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

Answer 4

2 - blood vessels

Question 5

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

Answer 5

3 - head trauma

Question 6

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

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

Answer 6

4 - pterion

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

Question 7

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

Answer 7

2 - meningeal artery

Located above the middle meningeal artery

Pterion region has think skull so more vulnerable

Question 8

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

Answer 8

• no

Patients initially lose, briefly regain and then lose consciousness again

Question 9

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

Answer 9

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

Question 10

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

Answer 10

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

Question 11

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

Answer 11

1 - fixed dilated pupil

Patient will also likely have nausea and vomiting due to concussion

Question 12

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

Answer 12

• no

Subarachnoid haemorrhage causes a thunderclap headache

Question 13

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?

Answer 13

• extra-dural haematoma

SHaped like a lemon

Question 14

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

Answer 14

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

Question 15

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

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

Answer 15

1 - craniotomy

Part of skull removed and blood removed