Extradural haemorrhage

Case contribution: Dr Radhiana Hassan

Clinical:

  • A 55 years old man
  • Involved in MVA
  • Complaint of headache, GCS=14/15

CT scan findings:

  • A lens-shaped hemorrhage in the right fronto-occipital region
  • It do not cross the suture
  • Compression effect to the brain parenchyma
  • Effacement of ipsilateral cerebral sulci
  • No significant midline shift
  • On bone window, a skull fracture is seen

Diagnosis: Traumatic right extradural hemorrhage

Discussion:

  • also known as an epidural hemorrhage
  • A collection of blood that forms between the inner surface of the skull and the endosteal layer.
  • They are usually associated with a history of head trauma and frequently associated skull fracture.
  • The source of bleeding is usually arterial, most commonly from a torn middle meningeal artery
  • EDHs are generally unilateral in more than 95% of cases, however, bilateral or multiple EDHs are reported.
  • Supratentorial location:¬†temporoparietal (60%), frontal (20%) and parieto-occipital (20%)
  • infratentorial¬† location (5%) in posterior fossa
  • Management is craniotomy with evacuation of blood
  • Surgical intervention if
    • EDH larger than 30 cm3, regardless of GCS
    • EDH with GCS <9

Progress of patient: 

  • Craniotomy and evacuation done

 

Author: radhianahassan