extradural haemorrhage

Question 1

what is it?

Answer 1

An extradural haematoma occurs when a collection of blood forms between the dura mater, the outermost meningeal layer, and the inner surface of the skull.

Question 2

what causes it?

Answer 2

Extradural haematomas are almost always secondary to traumatic head injury, most commonly with a fracture of the temporal or parietal bone which damages underlying vessels.
The most common vessel damaged is the middle meningeal artery, however extradural haematomas can also result from a venous bleed.

Question 3

what is the classic clinical course of symptoms?

Answer 3

Brief loss of consciousness following the initial traumatic head injury
A period of regained consciousness and apparent recovery (the lucid interval)
Subsequent deterioration with worsening symptoms and signs

Question 4

features?

Answer 4

Headache
Nausea and vomiting
Seizures
Limb weakness, numbness or other neurological symptoms
Confusion
External injuries e.g. signs of skull fractures, haematomas or lacerations on the head
Reduced level of consciousness
Seizures
Cushings Triad: Bradycardia, hypertension and irregular breathing (sign of raised intracranial pressure)
6th nerve palsy (a false localising sign secondary to raised intracranial pressure
Cerebrospinal fluid otorrhea or rhinorhoea (sign of dural tearing)
Unequal pupils
Focal neurological signs e.g. visual field defects, ataxia

Question 5

what are the bedside ix?

Answer 5

ECG
cap glucose

Question 6

what bloods done?

Answer 6

FBC
U&Es and LFTs
Coagulation screen
Group and save

Question 7

what imaging done>?

Answer 7

Non-contrast CT Head is the diagnostic investigation, looking for a lentiform or biconvex hyperdense extra-axial collection
Complications resulting from raised intracranial pressure such as midline shift or subfalcine/uncal herniation may necessitate urgent neurosurgical intervention

Question 8

what is this?

Answer 8

extradural haemorrhage

Question 9

what is the mx?

Answer 9

Patients with small extradural haematomas may be admitted for neurological observations and monitoring with serial imaging

Reverse any anticoagulant medication or coagulopathy, anticonvulsants for seizure, prophylactic abx for open skull fracture

Burr hole craniotomy may be used to evacuate the haematoma
Trauma craniotomy is another emergency procedure that can relieve raised intracranial pressure and evacuate the haematoma
Vessels with ongoing bleeding should be ligated or cauterised