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Extradural Haemorrhage Title Ñ Extradural Haemorrhage Definition Ñ Collection of blood in the extradural space Aetiology Ñ Head injury Pathogenesis Ñ Linear fracture of the skull vault tears middle meningeal artery Clinical Features History CNS Ñ Head injury: Followed by: · Lucid interval · Deteriorating level of consciousness Ñ Head injury: Followed by: · Fall in level of consciousness Ñ Head injury: Followed by: · Conscious level slow to improve Ñ Confusion Ñ Seizures Ñ Headache Ñ Vomiting Examination CNS Ñ Dilatation of ipsilateral pupil Ñ Hemiplegia with exaggerated reflexes and upgoing plantar: Contralateral Later: Ñ Bilateral signs Ñ Coning CVS Ñ Bradycardia: Increased intracranial pressure Ñ Raised blood pressure: Increased intracranial pressure RS Ñ Breathing deep and irregular: When coning Investigations Imaging Skull X-ray Ñ May show fracture across the course of the middle meningeal vessels CT Scan Ñ Biconvex (lens shaped) haematoma Management Control Surgery Ñ Evacuate haematoma Ñ Ligate bleeding vessel Prognosis Ñ Good if diagnosis is made early Ñ Poor if coma, pupillary abnormalities or decrebrate rigidity prior to operation
Extradural Haemorrhage
Title
Ñ Extradural Haemorrhage
Definition
Ñ Collection of blood in the extradural space
Aetiology
Ñ Head injury
Ñ Linear fracture of the skull vault tears middle meningeal artery
Clinical Features
History
CNS
Ñ Head injury:
Followed by:
· Lucid interval
· Deteriorating level of consciousness
· Fall in level of consciousness
· Conscious level slow to improve
Ñ Confusion
Ñ Seizures
Ñ Headache
Ñ Vomiting
Examination
Ñ Dilatation of ipsilateral pupil
Ñ Hemiplegia with exaggerated reflexes and upgoing plantar:
Contralateral
Later:
Ñ Bilateral signs
Ñ Coning
CVS
Ñ Bradycardia:
Increased intracranial pressure
Ñ Raised blood pressure:
RS
Ñ Breathing deep and irregular:
When coning
Investigations
Imaging
Skull X-ray
Ñ May show fracture across the course of the middle meningeal vessels
CT Scan
Ñ Biconvex (lens shaped) haematoma
Management
Surgery
Ñ Evacuate haematoma
Ñ Ligate bleeding vessel
Prognosis
Ñ Good if diagnosis is made early
Ñ Poor if coma, pupillary abnormalities or decrebrate rigidity prior to operation
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