Extradural Haemorrhage

Original article by Tom Leach | Last updated on 16/5/2014
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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.