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Extradural Haematoma:

This page is intended as a patient/relative information source only. It is not a substitute for professional medical advice.

What Is An Extradural Haematoma?

An extradural haematoma is a collection of blood within the extradural space in the skull. The extradural space is a ‘potential space’ between the bones of the skull and the dura (the layer covering the brain), which is usually attached to the under surface of the bone.

What Causes An Extradural Haematoma?

The most common cause of an extradural haematoma is head injury with an associated fracture of the skull bones. The head injury can cause damage to blood vessels and cause bleeding or bleeding can be from the fractured bone itself. Bleeding then collects in the potential space between the skull and dura. This collection of blood causes an increase in the pressures within the head. This build up of pressure can have a direct impact on the brain, but also causes a problem with the blood supply to the brain as the pressure inside the skull increases.

What Are The Symptoms Of An Extradural Haematoma?

Typically, people with extradural haematomas lose consciousness at the time of the initial head injury; they may then recover and have a ‘lucid interval’ where they may appear to feel and act relatively normally before becoming more poorly again as the blood collection begins to expand. Symptoms include confusion, agitation, feeling sick, headaches, speech problems and even loss of consciousness.

How Is An Extradural Haematoma Diagnosed?

All patients with significant head injury should be reviewed in hospital. Here a doctor or nurse will perform a full neurological examination. This will include checking your level of consciousness, looking for any sign of raised pressure within the head and examining the nerves that supply your face and limbs. Blood test may also be taken to ensure that your blood is clotting correctly.

If any abnormalities are detected you may have a CT scan, which images the brain and allows doctors to detect if any bleeding has occurred. CT scan can also show if any fractures have occurred at the time of injury.

A CT scan showing an extradural haematoma

How Is An Extradural Haematoma Treated?

If an extradural haematoma is detected, doctors will work to ensure that your clinical condition is stabilised. This may involve inserting drips, giving medications to help stabilise your blood pressure or help you to breathe if your conscious level deteriorates.

Occasionally very small extradural haematomas that are not expanding and not producing any significant symptoms, may be treated with observation and careful monitoring. However, most medium or large extradural haematomas (or even small ones that are making someone unwell) will require surgery, often urgently.

Surgery for an extradural haematoma usually involves a having craniotomy. A craniotomy is a procedure performed under general anaesthetic (being put to sleep) that involves removing a portion of the skull bone and removing the clot directly, this releases the pressure on the brain.

Sometimes small metal plates are screwed into position to fix any big fractures in the skull bone.

What Is The Outlook?

An extradural haematoma can be a very serious and potentially life-threatening condition.

Quick treatment can be a key priority for a good outcome as can a period of rehabilitation with the help of doctors, nursing staff, physiotherapists and occupational therapists.

There is the risk that extradural haematomas can have a lasting impact on both your physical and mental condition. You may develop weakness on one side of the body, seizures, or problems with speech (much like a typical ‘stroke’ picture). Sometimes these symptoms can improve over time with input from the rehabilitation team and medications.

As a general rule, the more poorly someone is prior to surgery, the higher the chances of lasting brain damage after surgery. Sadly, people are sometimes too poorly to tolerate surgery by the time that they reach hospital.

Some patients who are admitted with an extradural haematoma will be initially treated on our intensive care unit or our high dependency unit, where they can be closely monitored if required.

 

Page Author: Dr Adelle Fishlock, March 2011


Website created and edited by Ian Anderson