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Epidural Hematoma

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Dr Sumer Sethi
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A 17-year-old boy is brought to the emergency department by ambulance. He had been playing hockey and was struck on the head by a hockey ball approximately half an hour before admission. He lost consciousness briefly, but was able to walk from the scene. He is mildly confused, complaining of a severe headache, and has vomited four times. Examination He has a pulse rate of 63/min and a blood pressure of 170/110mmHg. During the course of the examination he becomes drowsy and his Glasgow Coma Score (GCS) drops to 3/15. He has a ‘boggy swelling’ over the right temple. His right pupil is dilated. NCCT head is shown.


This young man has sustained an extradural bleed. A direct blow to the temporo-parietal area is the commonest cause of an extradural haematoma. The bleed is normally arterial in origin. In 85 per cent of cases there is an associated skull fracture that causes damage to the middle meningeal artery. Only 20 per cent of patients have the classic presentation of a lucid interval between the initial trauma and subsequent neurological deterioration.


This situation represents a neurosurgical emergency. Without urgent decompression the patient will die. Unlike the chronic subdural, which can be treated with Burr hole drainage, the more dense acute arterial haematoma requires a craniotomy in order to evacuate it. The GCS of 3/15 would indicate that this patient is unlikely to be able to maintain his own airway and will almost certainly require intubation and ventilation prior to CT scanning.