Related Subjects:
|Subdural haematoma
|Extradural haematoma
The characteristic presentation of an extradural haematoma (EDH) includes a head injury followed by a brief period of unconsciousness, a subsequent lucid interval, and then a decline in consciousness as measured by the Glasgow Coma Scale (GCS). This is a medical emergency requiring urgent CT imaging and neurosurgical consultation.
About
- Extradural haematoma occurs due to bleeding outside the dura mater, contained within the periosteal suture lines of the skull.
- Often arterial in origin, typically involving the middle meningeal artery, making the condition severe and potentially life-threatening.
- If left untreated, EDH can lead to significant brain injury and rapid deterioration, potentially resulting in death.
Aetiology
- Usually associated with a head injury leading to bleeding from the middle meningeal artery.
- Bleeding occurs outside the dura mater, constrained by the skull’s periosteal suture lines.
- May also involve the middle meningeal vein.
- Frequently accompanied by a temporal or parietal skull fracture.
- Most common in males aged 20-30 years, often due to high-energy impacts.
Causes
- Falls, physical assaults, and sports-related injuries.
- Traumatic events, such as skiing accidents or birth trauma, especially in neonates.
Clinical Features
- Initial head injury often with visible superficial trauma.
- A lucid interval, during which the patient appears alert, followed by worsening symptoms as the haematoma expands.
- Progressive reduction in GCS, leading to eventual unconsciousness.
- Cheyne-Stokes respiration may develop as intracranial pressure increases.
Investigations
- Blood Tests: Full blood count (FBC), Urea & Electrolytes (U&E), and Liver Function Tests (LFT) to assess overall health and guide treatment.
- Non-contrast CT Scan: The primary diagnostic tool. Shows a biconvex (lens-shaped) hyperdensity confined by periosteal suture lines, often accompanied by midline shift and skull fracture. Additional signs of traumatic brain injury, such as cerebral contusions, may also be present.
Management
- Initial Stabilization: Ensure airway, breathing, and circulation (ABC). Intubate if GCS < 8. Administer IV fluids and arrange an urgent CT head scan.
- Neurosurgical Consultation: Essential for all EDH cases to assess the need for surgical intervention.
- Coagulopathy Management: Reverse any anticoagulant effects if the patient is on blood thinners.
- Surgical Clot Evacuation: Immediate evacuation is often life-saving. If a craniotomy is delayed, burr hole drainage may be necessary.
- Surgical Indications: Surgery is recommended for haematomas larger than 30 cm3irrespective of GCS. Craniotomy is performed at the area of maximum haematoma thickness.
- Postoperative Care: Intensive care monitoring, including intracranial pressure (ICP) and neuro-monitoring. Neurorehabilitation may be required following recovery.