extradural hemorrhage Flashcards
1
Q
define
A
An epidural haemorrhage results from rupture of one of the meningeal arteries that run between the dura and the skull. The middle meningeal artery is most commonly affected.
The usual cause is a skull fracture. Not uncommonly, the blow may be relatively trivial.
More than half of cases occur in persons below 20 years of age. Epidural haemorrhage is rare in persons over 40 years. In part, this can be explained by the dura becoming increasingly adherent to the skull with age.
2
Q
clinical features
A
- patient is often a young adult
- commonly follows trauma to the temporal or temporo-parietal region
- scalp oedema above the ear may be present
- concussion may be followed by temporary recovery of consciousness for minutes or hours before the onset of drowsiness and possibly coma - a characteristic phenomenon referred to as the “lucid interval”
- there may be an ipsilateral, dilated pupil on the side of the expanding lesion; a bilateral III nerve palsy may follow as rising intracranial pressure produces tentorial herniation
- there may be signs of intracranial compression
- there may be progressive contralateral hemiplegia
3
Q
ix
A
CT scan is mandatory
- The characteristic appearance of a CT of an extradural haemorrhage is of a biconvex, lozenge shaped area of increased density.
- Spread is limited by the adhesion of the dura to the skull.
- A midline shift with compression of the ipsilateral ventricle may be apparent.
A skull X-ray may reveal a fracture.(↑↑ risk of extradural haemorrhage)
CI: LP
4
Q
mx
A
- The treatment of extradural haemorrhage first involves identification of the site of haemorrhage using the CT scan.
- The haematoma is completely evacuated through a “horse shoe” craniotomy flap.
- If patient deterioration is rapid, provide temporary relief by means of a burr hole and craniectomy positioned centrally over the haematoma.
- Neuroprotective ventilation: intubation and ventilation
- Consider mannitol (1g/kg IV via central line)à↑ICP
