Extradural haematoma Flashcards
what is the definition of EDH?
Collection of blood between the dura mater and the bone usually cause by head injury
what is the epidemiology of EDH?
Around 10% of head injuries, 15% of fatal head injuries
what is the aetiology of EDH?
Trauma to the temple
Normally bleeding from middle meningeal artery
Associated with fracture of temporal or parietal bone causing laceration of the middle meningeal artery
what are the risk factors for EDH?
Adults, rarer <2yrs and >60yrs
what is the pathophysiology of EDH?
Blood accumulates rapidly over minute-hours between bone and dura
what are the key presentations of EDH?
May have a lucid period - Whilst haematoma is still small and there is still some bleeding - Doesn't really bother you physically - Can last several hours or even days - Followed by altered consciousness occurs slowly over hours rise in ICP brain compressed and displaced Headache Drowsiness Rapid neurological deterioration Herniation Nausea and vomiting Confusion Seizures
what are the signs of EDH?
Trauma Skull fracture Raise in ICP Rapid neurological deterioration Brain compressed and displaced Ipsilateral pupil dilates, coma, bilateral limb weakness, breathing becomes deep and irregular Signs of brainstem compression Bradycardia and raised BP = late signs
what are the symptoms of EDH?
Headache Drowsy Nausea and vomiting Confusion Seizures
what are the first line and gold standard investigations for EDH?
Imaging - acute bleed appears hyperdense on CT - bright white
Convex, does not conform to surface if brain
Bleeding limited by surface suture lines
Compression of brain- midline shift (look at falx cerebri and lateral ventricles)
Skull fracture may be evident
what are the differential diagnoses for EDH?
Transient ischemic attack, intracranial mass, or brain abscess
Epilepsy, carotid dissection and CO poisoning (lucid period)
Subdural haematoma, SA haemorrhage, meningitis
how is EDH managed?
Surgical emergency - death will be quick if not treated due to respiratory arrest
ABCDE emergency management
IV mannitol if ICP is raised
Neurosurgery - clot evacuation, and maintaining airway via intubation and ventilation of unconscious patient
how is EDH monitored?
post surgery care
what are the complications of EDH?
Herniation of the brain and permanent coma.
Normal pressure hydrocephalus, which can lead to weakness, headaches, incontinence, and difficulty walking.
Paralysis or loss of sensation (which began at the time of the injury)
what is the prognosis of EDH?
Death if not surgically treated, good outcome of surgery
