Extradural haemorrhage is usually caused by rupture of the middle meningeal artery in the temporo-parietal region. It can be associated with a fracture of the temporal bone. It occurs between the skull and dura mater.

PC:

• hit on the side of the head followed by features of raised ICP
• lucid interval
• vomiting
• confusion
• headache

The typical history is a young patient with a traumatic head injury that has an ongoing headache. They have a period of improved neurological symptoms and consciousness followed by a rapid decline over hours as the haematoma gets large enough to compress the intracranial contents.

Clinical examination -

• bruising to temple
• unilateral
• fixed dilated pupil

Investigations

Imaging:

• CT - On a CT scan they have a bi-convex shape and are limited by the cranial sutures (they can’t cross over the sutures).

Management

Most likely burr hole surgery