Extradural Haemorrhage

Question 1

What is an extradural haemorrhage?

Answer 1

bleeding + accumulation of blood in the extradural space

Question 2

Explain the aetiology of extradural haemorrhage

Answer 2

TRAUMA

Usually due to fracture of the temporal or parietal bones leading to rupture of the middle meningeal artery

Question 3

Describe the epidemiology of extradural haemorrhage

Answer 3

UK incidence: 20/10,000
10% of severe head injuries
M>F
Most commonly seen in YOUNG ADULTS

Question 4

Describe the time frame of symptoms of extradural haemorrhage

Answer 4

1. Immediate LOC
2. Temporary recovery “lucid interval”
3. Progressive deterioration in conscious level

Question 5

What is the gold standard investigation to be performed for extradural haemorrhage? Why?

Answer 5

Urgent CT Head
Check for a haematoma
Look for features of raised ICP (e.g. midline shift)

Question 6

Give a risk factor for extradural haemorrhage

Answer 6

Bleeding tendency

E.g. haemophilia, anticoagulant therapy

Question 7

Describe the appearance of extradural haemorrhage on CT

Answer 7

“Lemon shaped haematoma”

Bi-convex mass: due to haematoma expanding medially due to being unable to expand past the points at which the dura is tightly bound to the suture lines of the skull.

Question 8

List 5 symptoms of extradural haemorrhage

Answer 8

Headache
N+V
Confusion
LOC (immediately after head injury) followed by period of lucidity
Progressively decreasing level of consciousness (developing several hours after the initial injury)

Question 9

List 8 signs of extradural haemorrhage

Answer 9

Tenderness of the skull (in the context of injury)
Confusion
Reduced GCS
Cranial nerve deficits (e.g. oculomotor nerve palsy causing fixed dilation of the ipsilateral pupil)
Motor or sensory deficits of the upper and/or lower limbs (e.g. hemiparesis, paraesthesia)
Hyperreflexia + spasticity
Upgoing plantars (Babinski’s sign)
Cushing’s triad: bradycardia, HTN + irregular breathing.

Question 10

What other investigations may be performed in suspected extradural haemorrhage?

Answer 10

CBG: exclude hypoglycaemia as cause of reduced GCS
ECG: exclude heart block as cause of bradycardia
FBC: detect anaemia which may need correction
U+Es: exclude electrolyte abnormalities which may contribute to low GCS
CRP: if considering co-existing infection
Coagulation: exclude underlying coagulopathy
G+S: to allow transfusion of blood products, particularly relevant if pt needs to go to theatre