Extradural hemorrhage (summary)
Updates to Article Attributes
Extradural haemorrhages (EDH) represent collections of blood in the extradural (epidural) space. The haemorrhage sits between the skull superficially and the dura which overlies the brain parenchyma.
Reference article
This is a summary article; read more in our article on extradural haemorrhage.
Summary
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epidemiology
- young patients
- high-energy impact trauma
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presentation
- a headache (may be due to associated fracture)
- localising signs secondary to mass effect
- loss of consciousness
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pathophysiology
- the source of haemorrhage tends to be arterial
- associated skull fracture
- the middle meningeal artery is particularly at risk
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investigation
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non-contrastCT head (non-contrast) is quick, easy and readilyaccessibleavailable
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treatmenturgent consideration of neurosurgical interventionsurgical treatment: evacuation of clot through a burr holesmaller bleeds may be managed conservatively
Rolerole of imaging
- initial diagnosis
- assessment of associated mass effect
- assessment of associated injuries, e.g. skull fracture
- look for an underlying cause
- suggest further imaging
- follow up
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CT
- peripheral hyperdense biconvex extra-axial collection
- described as looking like a lens (lentiform) or egg (eggs-tradural)
- urgent consideration of neurosurgical intervention
- surgical treatment: evacuation of clot through a burr hole
- smaller bleeds may be managed conservatively
Radiographic features
Non-contrast CT is the imaging modality of choice for the investigation because it is highly sensitive for haemorrhage and fracture. Moreover, it is quick and highly available and is the safest option for a potentially sick patient.
CT
Extradural haematomas will be seen peripherally as a biconvex area of hyperdensity. This has been described as looking like a lens (lentiform) or an egg ("eggs"-tradural haemorrhage). The haemorrhage is well demarcated as it sits between the skull and brain parenchyma and does not cross the skull sutures.
They tend to be hyperdense (bright). However, active haemorrhage will be seen as an area of hypodensity (the non-clotted blood appears dark within the rest of the clotted haematoma).
CT may illustrate skull fractures or other parenchymal injuries. If the haemorrhage is of sufficient size, mass effect may be seen, e.g. midline shift, herniation.
-<strong>investigation</strong><ul><li>non-contrast CT head is quick and readily accessible</li></ul>- +<strong>investigation</strong><ul><li>CT head (non-contrast) is quick, easy and readily available</li></ul>
-<strong>treatment</strong><ul>-<li>urgent consideration of neurosurgical intervention</li>-<li>surgical treatment: evacuation of clot through a burr hole</li>-<li>smaller bleeds may be managed conservatively</li>-</ul>-</li>-</ul><h4>Role of imaging</h4><ul>- +<strong>role of imaging</strong><ul>
-</ul><h4>Radiographic features</h4><p>Non-contrast CT is the imaging modality of choice for the investigation because it is highly sensitive for haemorrhage and fracture. Moreover, it is quick and highly available and is the safest option for a potentially sick patient.</p><h5>CT</h5><p>Extradural haematomas will be seen peripherally as a biconvex area of hyperdensity. This has been described as looking like a lens (lentiform) or an egg ("eggs"-tradural haemorrhage). The haemorrhage is well demarcated as it sits between the skull and brain parenchyma and does not cross the skull sutures.</p><p>They tend to be hyperdense (bright). However, active haemorrhage will be seen as an area of hypodensity (the non-clotted blood appears dark within the rest of the clotted haematoma).</p><p>CT may illustrate skull fractures or other parenchymal injuries. If the haemorrhage is of sufficient size, mass effect may be seen, e.g. <a href="/articles/midline-shift">midline shift</a>, <a href="/articles/cerebral-herniation">herniation</a>.</p>- +</ul>
- +</li>
- +<li>
- +<strong>radiographic features</strong><ul><li>CT<ul>
- +<li>peripheral hyperdense biconvex extra-axial collection</li>
- +<li>described as looking like a lens (lentiform) or egg (eggs-tradural)</li>
- +<li> </li>
- +</ul>
- +</li></ul>
- +</li>
- +<li>
- +<strong>treatment</strong><ul>
- +<li>urgent consideration of neurosurgical intervention</li>
- +<li>surgical treatment: evacuation of clot through a burr hole</li>
- +<li>smaller bleeds may be managed conservatively</li>
- +</ul>
- +</li>
- +</ul><h4>Radiographic features</h4><p>Extradural haematomas will be seen peripherally as a biconvex area of hyperdensity. This has been described as looking like a lens (lentiform) or an egg ("eggs"-tradural haemorrhage). The haemorrhage is well demarcated as it sits between the skull and brain parenchyma and does not cross the skull sutures.</p><p>They tend to be hyperdense (bright). However, active haemorrhage will be seen as an area of hypodensity (the non-clotted blood appears dark within the rest of the clotted haematoma).</p><p>CT may illustrate skull fractures or other parenchymal injuries. If the haemorrhage is of sufficient size, mass effect may be seen, e.g. <a href="/articles/midline-shift">midline shift</a>, <a href="/articles/cerebral-herniation">herniation</a>.</p>
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