aka Epidural Haematoma
- Classically presents with neurological signs after a lucid interval after some kind of head trauma. Usually a blow to the head in the temporal region.
- Head trauma often results 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
- There is often no other sign of injury or trauma
- Pupil asymmetry – due to IIIrd cranial nerve compression
- Impaired consciousness
- Headache (severe)
- Upgoing plantars
- Dilation of ipsilateral pupil
- Bilateral limb weakness
- Bradycardia – late sign
- ↑BP – late sign
- Death due to respiratory arrest
- 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
- Urgent decompression is required
- Start with ABCD, and give high flow oxygen. Maintain SBP >90mmHg
- Sit up in bed if possible
- Call Neurosurgery!
- 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.