Condition- Epidural Haemorrhage

Question 1

What is an extradural haemorrhage?

Answer 1

Bleeding and accumulation of blood in the potential extradural space between the dura mater and the skull

Question 2

What is the most common cause of EDH?

Answer 2

Trauma

Usually due to fracture (near the temple in the PTERION region) leading to rupture of the middle meningeal artery (and vein)

May also be due to tear in dural venous sinus

Question 3

Name one risk factor which can exacerbate the onset of EDH…

Answer 3

Increased bleeding tendency:

• Haemophilia
• Anticoagulant therapy

Question 4

How can you distinguish EDH from the other types of haemorrhages? What is a key feature of this?

Answer 4

Head injury with temporary loss of consciousness or drowsiness–> lucid interval–> decline in consciousness afterwards as ICP rises.

Question 5

List some of the presenting symptoms of EDH…

Answer 5

• Lucid interval following head trauma
• Decrease in consciousness
• Severe worsening headache
• Vomitting
• Confusion
• Seizues
• Coma

Question 6

List some of the signs of EDH

Answer 6

• Scalp trauma or fracture
• Deteriorating GCS
• Signs of raised ICP
  
  • dilated, unresponsive pupil on side of injury
  • Cushing’s reflex- bradycardia and hypertension
• Hemiparesis
• Brisk reflexes and plantar extension
• Brainstem compression- deep and irregular breathing
• Coma-> resp arrest -> death

Question 7

List some appropriate investigations for a patient with extradural haemorrhage…

Answer 7

• URGENT CT SCAN: see haematoma which is lens shaped- because dura mater keeps the blood localised in one place
  
  • Can see signs of raised ICP (midline shift)
• X-ray: may show skull fracture

LUMBAR PUNCTURE IS CONTRAINDICATED

Question 8

Which sort of haemorrhage is this? What can cause this?

Answer 8

• Lemon-shaped haemorrhage + midline shift indicative of Extra-dural Haemorrhage
• Trauma to the pterion + rupture of the middle meningeal artery