Extradural Haemorrhage Flashcards
What is extradural haemorrhage/haematoma?
An acute bleed between the dura mater and the inner surface of the skull.
What is the common cause of extradural haematoma?
Skull trauma in the temporoparietal region (pterion)
What percentage of extradural haematoma cases are associated with skull fractures?
75%.
Which artery is commonly involved in extradural haematomas?
Middle meningeal artery (located just beneath pterion region of skull)
What can occur if an extradural haematoma continues to enlarge?
Increased intracranial pressure, midline shift, and herniation.
What does the Monro-Kellie doctrine describe?
The relationship between contents of the skull and intracranial pressure (ICP).
3 substances within skull: brain tissue, CSF, blood.
Some initial compensation for minor increase in one of the substances, easily overwhelmed meaning even small increase in a substance caused dramatic rise in ICP
What is a classic presentation of extradural haematoma?
History of head trauma followed by a ‘lucid interval’ and then progressively decreasing level of consciousness.
What are common symptoms of extradural haematoma?
- Headache
- Nausea and vomiting
- Confusion
What are some examination findings in a patient with extradural haematoma?
- Tenderness of skull
- Confusion
- Decreasing level of consciousness
- Cranial nerve deficits
- Motor and sensory deficits
- Hyperreflexia and spasticity
- Uptoing plantar reflex (Babinski’s sign)
- Cushing’s triad (bradycardia, hypertension, deep/irregular breathing)
What is Cushing’s triad/reflex?
Physiologic response to raised ICP.
Characterised by bradycardia, hypertension, deep/irregular breathing.
What imaging modality is used to diagnose extradural haematoma?
CT head.
Describe the appearance of an extradural haematoma on a CT scan.
Bi-convex ‘lemon-shaped’ mass that expands medially, unable to expand past suture lines.
What is the initial management for extradural haematoma?
ABCDE, correct coagulation studies, prophylactic antibiotics, anticonvulsants, and ICP reducing agents (mannitol, barbituates).
What are some surgical managements for extradural haematoma?
Burr hole craniotomy
Trauma craniotomy
Hemicraniotomy (decompressive craniotomy)
What factors contribute to a good prognosis in extradural haematoma?
Early evacuation of haematoma.
List factors that indicate poor prognosis in extradural haematoma.
- Low GCS at presentation
- No history of lucid interval
- Pupil abnormalities
- Decerebrate injury
- Pre-existing brain injury
