Extradural haemorrhage

Question 1

how does an extradural haemorrhage typically present?

Answer 1

trauma to the had
brief loss of consciousness followed by regaining consciousness (lucid interval), then subsequent rapid deterioration in GCS

acute severe headache
contralateral hemiplegia

Question 2

what features on CT scan are indicative of an extradural haemorrhage?

Answer 2

biconvex / lentiform heterogeneous hyper density extra-axial collection

Question 3

apart from the hyper density of the EDH, what other features might you find on head CT?

Answer 3

mid line shift
skull fracture
effacement of the ventricles
subfalcine / uncle herniation

Question 4

how is an EDH managed?

Answer 4

non-surgical
- serial head CT scans

surgical
- burr holes and craniotomy to evacuate clot

Question 5

what is the criteria for surgical treatment of EDH?

Answer 5

volume of haematoma > 30cm3 (regardless of GCS)
midline shift > 5mm
haematoma thickness > 15mm

Question 6

what is the criteria for non-surgical treatment of EDH?

Answer 6

volume of haematoma < 30 cm
midline shift < 5mm
haematoma thickness < 15mm
no neurological deficit and GCS > 8

Question 7

what are possible complications of surgery for the treatment of EDH?

Answer 7

bleeding (intra op and post op)
seizure
infection 
hydrocephalus
meningitis
neurological deficits related to the area of the brain 
coma
death

Question 8

what is the DVLA regulations with regard to EDH?

Answer 8

if you have had EDH you cannot drive for 6-12 months

Question 9

what are the two layers of the dura matter?

Answer 9

periosteal layer

meningeal layer

Question 10

a patient presents to A&E after having a hit on the head when playing rugby. He lost consciousness for a minute on the pitch but regained consciousness. He complains of a severe headache.

what are your differentials?

Answer 10

EDH
SDH
SAH
Diffuse axonal injury 
Intracranial abscess