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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.

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