Subdural/Extradural haemorrhage

Question 1

What are the symptoms of a subdural haemorrhage?

Answer 1

fluctuating levels of consciousness
\+/- insidious physical or intellectual slowing
sleepiness
headache
personality change
unsteadiness

Question 2

What are the signs of a sudural haemorrhage?

Answer 2

raised ICP
seizures
localising neurological symptoms - unequal pupils, hemiparesis, occur late and often long after the injury

Question 3

What would imaging show in a subdural haemorrhage?

Answer 3

CT/MRI - shows clot +/- midline shift

crescent-shaped collection of blood over 1 hemisphere

Question 4

What is the differential to a subdural haemorrhage?

Answer 4

stroke
dementia
CNS masses - tumours, abscess, neurocysticercosis

Question 5

What is the treatment for subdural haemorrhage?

Answer 5

irrigation/evacuation via burr twist drill and burr hole craniostomy
craniotomy 2nd line
address the cause of trauma

Question 6

What are the risk factors subdural haemorrhage?

Answer 6

the elderly
falls - epileptics, alcoholics
anticoagulation

Question 7

What are often the cause of an epidural/extradural bleed?

Answer 7

fractured temporal or parietal bone causing laceration of the middle meningeal artery and vein.

Question 8

Where does the blood collect in an extradural/epidural haemorrhage?

Answer 8

between the bone and the dura. - any tear in a dural venous sinus can cause it

Question 9

What is the typical pattern of presentation of an extradural/epidural bleed?

Answer 9

deteriorating consciousness with a lucid period. Can be a few hours to a few days before a drop in GCS is seen due to rising ICP

head injury with no initial loss of consciousness or apparent recovery after injury

Question 10

What are the typical symptoms of a patient with an extradural haemorrhage?

Answer 10

increasingly severe headache
vomiting
confusion
fits

hemiparesis with brisk reflexes and an upgoing plantar

later: ipsilateral pupil dilation, coma deepens, bilateral leg weakness, breathing becomes deep ad irregular (brainstem compression)

Question 11

How does an extradural/epidural haemorrhage appear on CT?

Answer 11

shows haematoma - biconvex/lemon shaped, midline shift

Question 12

What is the management of an extradural/epidural haemorrhage?

Answer 12

stabilise and transfer urgently for clot evacuation +/- ligation of the bleeding vessel
measures to decrease ICP - mannitol etc