extradural haemorrhage

Question 1

definition of extradural haemorrhage

Answer 1

bleed into the epidermal space

blood accumulates between the bone and the dura

Question 2

aetiology of extradural haemorrhage

Answer 2

traumatic skull fracture

fractured temporal or parietal bone = laceration of the middle meningeal artery and vein - typically after trauma to temple just lateral to eye

any tear in dural venous sinus

epidural space is a potential space between dura mata and calvarium

increased ICP -> CN3 palsy, herniation

Question 3

epidemiology of extradural haemorrhage

Answer 3

female more

20-30yrs

Question 4

sx of extradural haemorrhage

Answer 4

initially no loss of consciousness and then deteriorating consciousness,

or after initial drowsiness post injury seems to have resolved

lucid interval pattern is common

lucid pattern may last a few hours to a few days before bleed declares itself with low GCS

increasingly severe headache

vomiting

confusion

seizure

Question 5

signs of extradural haemorrhage

Answer 5

low GCS - from rising ICP

hemiparesis with brisk reflexes and up going plantar

if bleeding continues - ipsilateral pupil dilates, coma deepens, bilateral limb weakness, breathing deep and irregular (brainstem compression)

bradycardia and increased BP are late signs

death follows a period of coma and is due to resp arrest

Question 6

Ix for extradural haemorrhage

Answer 6

CT - haematoma (biconvex/lens shape- more rounded than sickle shape in subdural as dural attachments to the skull keep it more localised)

skull XR may be normal or show fracture lines crossing the course of the middle meningeal vessels

LP CONTRAINDICATED

differentials: epilepsy, carotid disection, CO poisoning

Question 7

mx of extradural haemorrhage

Answer 7

if no neuro deficit - then observe
definitive mx is craniotomy and evacuation of haemotoma