Makindo Medical Notes

🧠 The classic presentation of an Extradural Haematoma (EDH) is: ➡️ Head injury → brief loss of consciousness → lucid interval → rapid decline in GCS. 🚨 This is a neurosurgical emergency requiring urgent CT imaging and intervention.

💡 About

• EDH = bleeding between the dura mater and skull, confined by the skull’s periosteal suture lines.
• Classically arterial, most often from the middle meningeal artery.
• Rapidly progressive → may cause brain herniation if untreated.
• Accounts for ~2% of head injuries, typically in young adults (20–30 years), often after high-impact trauma.

🔎 Aetiology & Causes

• Rupture of the middle meningeal artery (or vein).
• Associated with temporal/parietal skull fractures.
• Common causes:
  • Falls 🪂
  • Road traffic collisions 🚗
  • Assaults 🥊
  • Sports injuries (e.g., skiing) ⛷️
  • Rarely: birth trauma in neonates 👶

🩺 Clinical Features

• Initial head trauma ± scalp wound.
• Lucid interval → temporary recovery → rapid neurological deterioration.
• ↓ GCS, confusion, drowsiness, then coma.
• Focal neurology (e.g., hemiparesis, dilated ipsilateral pupil from CN III palsy).
• Raised ICP signs: Cheyne–Stokes respiration, bradycardia, hypertension (Cushing’s triad).

🧪 Investigations

• CT Head (Gold Standard):
  • Biconvex (lens-shaped) hyperdense lesion.
  • Confined by suture lines (unlike subdural haematoma).
  • May show midline shift ± skull fracture.
• Bloods: FBC, U&E, LFTs, clotting screen (relevant if anticoagulated).

⚡ Management

• Initial ABC resuscitation: Secure airway, give O₂, IV fluids. Intubate if GCS < 8.
• Urgent neurosurgical referral in all suspected cases.
• Reverse coagulopathy (vitamin K, PCC if on warfarin; stop antiplatelets if safe).
• Surgery:
  • Immediate evacuation indicated if clot >30 cm³, thickness >15 mm, midline shift >5 mm, or GCS ≤8 with focal deficit.
  • Craniotomy = definitive treatment.
  • Burr hole may be lifesaving if deterioration occurs before theatre access.
• Post-operative: ICU care with ICP monitoring, neuro-rehab as required.

📋 Key Exam Tips

✅ Lucid interval is the buzzword for EDH (but not always present).
✅ CT: biconvex/lens-shaped bleed, confined by sutures.
✅ Differentiate from Subdural Haematoma (crescent-shaped, not limited by sutures).
✅ Always think middle meningeal artery rupture in temporal fracture.