Extradural Haemorrhage
aka Epidural Haemorrhage
Blood collects between the dura mater and the bone of the skull. The dura is stripped away from the skull – indicating a high pressure bleed. On CT and MRI, it has a classical lentiform (lens) shaped appearance.
Pathology
Due to a bleed in the extradural space, usually from the middle meningeal artery and/or vein. Typically the result of head trauma around the eye, resulting in
fracture to the temporal or parietal bones.
Presentation
- Classically presents with neurological signs after a lucid interval after some kind of head trauma. For example:
- Head trauma resulting in no initial signs / symptoms, then about 24 hours later, the patient becomes drowsy
- Head trauma causing some initial headache and drowsiness which resolves. Then hours later, drowsiness and other signs occur
- The lucid interval can be from a few hours to a few days.
Signs and symptoms include:
- Drowsiness
- Impaired consciousness
- Headache (severe)
- Vomiting
- Seizures
- Confusion
- Hemiparesis
- Upgoing plantars
- Coma
- Dilation of ipsilateral pupil
- Bilateral limb weakness
- Bradycardia – late sign
- ↑BP – late sign
- Death due to respiratory arrest
Investigations
- CT / MRI – shows a lens shaped lesion. This well circumscribed and well contained blood is due to the strong adherence of the dura mater to various structures in the skull.
- X-ray – may show fractures of the skull. If fractures are present then you need to do a CT as there is a high risk of extradural haemorrhage
- Lumbar puncture is CONTRAINDICATED
Management
- Surgery – is usually the first line treatment. The blood can be evacuated, and the bleeding lesion ligated. Prognosis is excellent if early stages, but poor if coma or pupil signs.
- See more at: http://almostadoctor.co.uk/content/systems/neurology-psychiatry/neurology/extradural-haemorrhage#sthash.aQ174pD9.dpuf
