Extradural Haemorrhage

Question 1

Define Extradural Haemorrhage

Answer 1

Collection of blood between the inner layer of the skull and the outer layer of the dura (periosteal layer)

Question 2

Aetiology of Extradural Haemorrhage

Answer 2

Head trauma -> fracture (motor vehicle injury, fall assault)
Most commonly of the temporal bones (thinnest part of the cranial vault), leading to a rupture in the middle meningeal artery

Arterial bleeding -> rapid/acute accumulation of blood, stripping dura from the skull -> raised ICP -> brain parenchyma compression

Question 3

Symptoms of Extradural Haemorrhage

Answer 3

Classically:

1. Temporary loss of consciousness
2. lucid interval
3. Progressive deterioration in conscious level

Hx head trauma
Acute onset headache

Question 4

Signs of Extradural Haemorrhage on examination

Answer 4

Scalp trauma or fracture
Gradual drop in GCS
Signs of raised ICP (papilloedema, dilated unresponsive pupil on side of injury)

Late signs:
Abnormal posture (decorticate + decerberate)
Cushing’s reflex (bradycardia, hypertension, irregular breathing)

Question 5

Investigations for Extradural Haemorrhage

Answer 5

Urgent CT

Arterial bleed -> produces convex/lens-shaped/lemon shaped haematoma (HYPERdense)

Raised ICP:
Midline shift
Compression of ventricles
Obliteration of basal cisterns
Sulcal effacement