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