Extradural haemorrhage

Definition:

• Extradural Haemorrhage (EDH) is a type of traumatic brain injury where blood accumulates between the inner surface of the skull and the outer layer of the dura mater, the outermost meningeal layer.

Epidemiology:

• Commonly seen in young adults and children.
• Often associated with motor vehicle accidents, falls, or sports injuries.

Pathophysiology:

• Typically caused by a tear in the middle meningeal artery, secondary to a skull fracture.
• The accumulation of blood in the epidural space leads to increased intracranial pressure, compression of brain tissues, and potential herniation.

Clinical Features:

• Initial loss of consciousness, followed by a lucid interval, then progressive deterioration in consciousness.
• Headache, nausea, vomiting.
• Focal neurological deficits such as hemiparesis.
• Signs of increased intracranial pressure, including altered mental status and pupillary dilation (usually ipsilateral to the hematoma).

Diagnosis:

• CT scan of the head is the diagnostic modality of choice, typically showing a biconvex (lentiform) hematoma.
• MRI can be used in certain cases for further evaluation.

Management:

• Neurosurgical intervention is often required, usually involving craniotomy to evacuate the hematoma.
• Medical management of increased intracranial pressure.
• Monitoring in an intensive care setting, especially for signs of herniation and neurological deterioration.

Prognosis:

• The outcome depends on the size of the hematoma, the extent of brain injury, and the rapidity of intervention.
• Early diagnosis and prompt surgical treatment generally result in a good prognosis.