Extradural haemorrhage (A&E) Flashcards
Define extradural haemorrhage.
Bleeding between skull & dura mater
AKA epidural haemorrhage
Which demographic does extradural haemorrhage usually happen in? (2)
- M>F
- 20-30y
What usually causes extradural haemorrhage, and where?
- usually caused by ‘low-impact trauma’ - head injury (blow to the head, fall)
- most commonly an arterial bleed - rupture of middle meningeal artery
- pterion is common site of rupture - thinnest part of skull where middle meningeal artery lies
What can extradural haemorrhage lead to? (2)
- expanding haematoma
- –> uncus of temporal lobe herniates around the tentorium cerebelli and patient develops a fixed and dilated pupil due to compression of the parasympathetic fibres of CN III
- brain herniation (coning)
What is the classic presentation of extradural haemorrhage?
Presents with sudden onset soon after injury following a brief lucid interval:
- initial loss of consciousness after head injury
- temporary consciousness recovery + return to normal neurological function (lucid interval)
- neurological status declines again - due to haematoma expansion
What might we see on examination of extradural haemorrhage? (5)
- contralateral neurological deficits
- headache
- reduced GCS –> confusion
- fixed and dilated pupils
- Cushing’s reflex - hypertension and bradycardia
Where are neurological deficits seen in extradural haemorrhage?
Contralaterally
What signs of raised ICP can we see in extradural haemorrhage? (2)
- headache
- confusion (decreased GCS)
What nerve can be compressed in extradural haemorrhage and what can we see?
Compression of parasympathetic fibres of CN III –> fixed, dilated pupils
What is the Cushing’s reflex in extradural haemorrhage?
Hypertension and bradycardia
What are some risk factors for extradural haemorrhage? (3)
- low-impact trauma
- assault
- sporting injury
What is the first-line investigation for extradural haemorrhage?
Non-contrast head CT
What would you see on non-contrast head CT in extradural haemorrhage?
- hyperdense (bright) biconvex lesion (lemon-shaped) limited by suture lines of skull
- think EPIdural = PIE = LEMON
- 95% of cases are supratentorial, of which 60% are in temporoparietal region
- check for secondary features of mass effect on CT scan e.g. midline shift or subfalcine/uncal herniation - may require urgent neurosurgical intervention
What are some differential diagnoses for extradural haemorrhage? (7)
- subdural haemorrhage
- subarachnoid haemorrhage
- intracerebral haemorrhage
- delirium
- meningitis
- intracranial mass
- migraine
What is the management plan for extradural haemorrhage? (6)
- conservative monitoring
- BP reduction - IV mannitol
- severe: burr holes to evacuate haematoma + craniotomy
- stop anticoagulation/antiplatelets
- can give reversal agents
- prophylactic anticonvulsants
