Extradural Haemorrhage

Question 1

outline a typical presentation for an extradural haemorrhage?

Answer 1

Head trauma

LOC- lucid interval

headache after lucid interval and decreasing GCS

symptoms of raised ICP

Question 2

define extradural haemorrhage?

Answer 2

Bleeding and accumulation of blood in the extradural space – between dura mater and skull

Question 3

outline the aetiology of extradural haemorrhage?

Answer 3

TRAUMA

fracture of temporal and partietal bones

rupture of middle meningeal artery and vein

TRAUMA TO PTERION REGION

( Can also be due to tear in dural venous sinus)

Question 4

what are the risk factors for an extradural haemorrhage?

Answer 4

alcohol- binge drinking-> falls, fights

bleeding tendency-> haemophillia, anitcoagulant

Question 5

summarise the epidemiology of an extradural haemorrhages?

Answer 5

UK incidence: 20/10,000

10% of severe head injuries

Most commonly seen in YOUNG ADULTS

Question 6

what are the presenting symptoms of an extradural haemorrhage?

Answer 6

Head injury with temporary loss of consciousness/drowsiness

Followed by lucid interval – resolved consciousness levels

Followed by progressive deterioration in conscious level (GCS) – as ICP rises (bradycardia +/- HT)

Increasingly severe headache, vomiting, confusion and fits follow +/- hemiparesis with brisk reflexes and upgoing plantar.

If bleeding continues, ipsilateral pupil dilates, coma deepens, bilateral limb weakness develops and breathing becomes deep and irregular (brainstem compression)

Other focal neuro deficits e.g. aphasia, vis fields defects, numbness and ataxia

Tear to dura => otorrhea or rhinorrhea

Question 7

what are the signs of subdural haemorrhage on physical examination?

Answer 7

Scalp trauma or fracture

Headache

Deteriorating GCS

Signs of raised ICP

• E.g. dilated, unresponsive pupil on the side of the injury

Cushing’s Reflex (NS responding to raised ICP causing…)

• Hypertension
• Bradycardia
• Irregular breathing

Question 8

what is the cushing’s reflex and what is the triad of symptoms?

Answer 8

NS responding to increase in ICP

• hypertension
• bradycardia
• irregular breathing

Question 9

what are the appropriate investigations for an extradural haemorrhage?

Answer 9

Urgent CT Scan

Check for a haematoma ( LEMON SHAPE) – may also get a contracoup injury on opposite side – due to acceleration-deceleration forces during injury

Look for features of raised ICP (e.g. midline shift)

NOTE: lumbar puncture to be avoided, especially if raised ICP has not been excluded