Extradural Haemorrhage Flashcards
Where does blood collect in an extradural haemorrhage?
Between the inner surface of the skull and the periostial dura matter
What are extradural haemorrhages usually secondary to?
Trauma and/or skull fracture
Typically low impact - blow to head or fall
Among what age group do extradural haemorrhages usually occur?
Younger patients 50% < 20
What artery is most commonly severed in extradural haemorrhages?
Middle meningeal artery
EDH is supratentorial in what percentage of cases?
95%
What is the classic presentation of EDH?
Initial LOC due to impact of the injury, which is briefly regained and then rapidly lost.
The brief regain in consciousness is termed the LUCID INTERVAL
As the haematoma enlarges, what can happen?
Rise in ICP causing compression of brain - brain structures can herniate
The uncus of the temporal lobe can herniate around the tentorium cerebelli -> fixed dilated pupil due to compression of parasympathetic fibres of CN III
On imaging, what does an EDH look like?
A lemon - appears biconvex (or lentiform)
collection limited by suture lines of the skull
How can small EDHs be managed?
Conservatively with neurological follow up
How are large EDHs managed?
Refer to neurosurgery for craniotomy and clot evacuation. May need ligation of bleeding vessel
What bones of the skull are typically affected?
Temporal or parietal bone
Weak point: pterion
How long can a lucid interval last?
A few hours to a few days
After the lucid period, what symptoms can follow?
Reducing GCS Severe headache Vomiting Confusion Seizures Hemiparesis Brisk reflexes Up going plantars
If bleeding continues - signs and symptoms associated with brainstem compression, Cushing’s reflex
Should an LP be done?
No
