Extradural haematoma

Characteristic picture is head injury and a short period of unconsciousness, followed by a period of regained consciousness (lucid interval) and then a fall in GCS. Urgent CT and Neurosurgical consult.

About

• Bleeding outside the dura limited only by periosteal suture lines
• Often arterial so often clinically severe and life-threatening
• Can cause significant brain injury and rapid death

Aetiology

• Usually related to a head injury with bleeding from middle meningeal artery
• Bleeding outside the dura limited only by periosteal suture lines
• Bleeding may be from middle meningeal vein or artery
• An associated temporal or parietal fracture may be seen
• Most commonly in males aged 20-30

Cause

• Falls, assaults, sporting injuries
• Skiing, Birth trauma

Clinical

• Head injury with superficial trauma visible
• Lucid period after head injury until bleed becomes symptomatic
• Reduced Glasgow coma scale
• Cheyne stokes respiration

Investigations

• FBC, U&E,LFT
• Non-contrast CT is diagnostic showing a biconvex area of hyperdensity from the inside of the skull and there may be midline shift and a visible skull fracture. Cerebral contusion and other signs of traumatic brain injury may also be seen.

Management

• ABC, Intubation if GCS < 8. IV fluids urgent CT head and Neurosurgical consult.
• Reverse any coagulopathy. Urgent clot evacuation and drainage can be life-saving.
• Recommended surgery in all those with extradural > 30 cm3 regardless of GCS. This may be Burr holes for haematoma evacuation if access to craniotomy delayed. Otherwise Craniotomy over the point of maximum haematoma thickness.
• Intensive care, ICP and neuromonitoring, neurorehabilitation