"Extradural haematoma (haemorrhage) (EDH), or epidural haematoma (haemorrhage), is caused by moderate to severe head trauma, sufficient to fracture the skull and lacerate a blood vessel, often the middle meningeal artery. Forceful arterial haemorrhage strips the periosteal layer of the dura mater from the calvarium to form a biconvex haematoma which is usually limited by the sutures. A large EDH causes a precipitous rise in intracranial pressure and brain herniation which constitutes a neurosurgical emergency."
"Extradural haematoma (haemorrhage) (EDH), or epidural haematoma (haemorrhage), is caused by moderate to severe head trauma, sufficient to fracture the skull and lacerate a blood vessel, often the middle meningeal artery. Forceful arterial haemorrhage strips the periosteal layer of the dura mater from the calvarium to form a biconvex haematoma which is usually limited by the sutures. A large EDH causes a precipitous rise in intracranial pressure and brain herniation which constitutes a neurosurgical emergency."
"EDH is typically seen in adults under 50 years and in children who are injured in traffic accidents, high energy falls, or by a blow to the head. Up to 80% occur in males."
"Posterior fossa EDH is rare ("
"The morphology of EDH is best understood by reviewing the anatomy of the calvarium and dura. An EDH is located on the inside of the skull, between the inner table of the skull and the parietal layer of the dura mater. As a result, extension is usually limited by the calvarial sutures; the periosteum exits through the suture and is continuous with the extracranial periosteal layer. This is resonsible for the distinguishing features of EDH; in contrast, subdural haematomas are not limited by sutures and spread more widely, adopting a crescentic shape."
"The morphology of EDH is best understood by reviewing the anatomy of the calvarium and dura. An EDH is located on the inside of the skull, between the inner table of the skull and the parietal layer of the dura mater. As a result, extension is usually limited by the calvarial sutures; the periosteum exits through the suture and is continuous with the extracranial periosteal layer. This is resonsible for the distinguishing features of EDH; in contrast, subdural haematomas are not limited by sutures and spread more widely, adopting a crescentic shape."
"The morphology of EDH is best understood by reviewing the anatomy of the calvarium and dura. An EDH is located on the inside of the skull, between the inner table of the skull and the parietal layer of the dura mater. As a result, extension is usually limited by the calvarial sutures; the periosteum exits through the suture and is continuous with the extracranial periosteal layer. This is resonsible for the distinguishing features of EDH; in contrast, subdural haematomas are not limited by sutures and spread more widely, adopting a crescentic shape."
"EDH can cross venous sinuses and displace them from the skull where they deviate from sutures; venous sinuses are located between the parietal and visceral layers of the dura."
"Importantly, an EDH can cross sutures, and this is facilitated by fractures that involve and widen sutures (diastasis), and in vertex EDH which displaces the superior sagittal sinus away from the inner table of the skull 6. This is more common in children, and in abusive head trauma, with one series finding that up to 11% of EDH in children cross sutures 5. Venous haemorrhage is important to recognise because of the possibility of catastrophic intraoperative haemorrhage."
"Importantly, an EDH can cross sutures, and this is facilitated by fractures that involve and widen sutures (diastasis), and in vertex EDH which displaces the superior sagittal sinus away from the inner table of the skull 6. This is more common in children, and in abusive head trauma, with one series finding that up to 11% of EDH in children cross sutures 5. Venous haemorrhage is important to recognise because of the possibility of catastrophic intraoperative haemorrhage."
"Importantly, an EDH can cross sutures, and this is facilitated by fractures that involve and widen sutures (diastasis), and in vertex EDH which displaces the superior sagittal sinus away from the inner table of the skull 6. This is more common in children, and in abusive head trauma, with one series finding that up to 11% of EDH in children cross sutures 5. Venous haemorrhage is important to recognise because of the possibility of catastrophic intraoperative haemorrhage."
"It can be used to evaluate nontraumatic cause (i.e. AVM) of extradural haematomas. Rarely angiography can demonstrate middle meningeal artery laceration and contrast extravasation from the middle meningeal artery into paired middle meningeal veins known as "tram track sign"."
"EDH volume greater than 30 cm³ on CT, regardless of GCS"
"EDH volume greater than 30 cm³ on CT, regardless of GCS"
"EDH thickness greater than 15 mm or midline shift greater than 5 mm in a patient with neurological symptoms or deterioration"
"comatose patients (GCS"
"any neurological deterioration attributable to EDH (e.g. decreasing GCS, new focal neurological deficits, pupillary changes), even if initial imaging criteria are not met"
"any neurological deterioration attributable to EDH (e.g. decreasing GCS, new focal neurological deficits, pupillary changes), even if initial imaging criteria are not met"
"posterior fossa EDH: risk of rapid brainstem compression"
"EDH enlargement on serial imaging or presence of active arterial bleeding, especially with concurrent subarachnoid haemorrhage"
"Venous EDH can bleed copiously during surgery; preoperative recognition and planning are important to mitigate the risks."
"further signs of increased intracranial pressure, e.g. bradycardia, hypertension, coma or even death"
Expected headings
"Angiography"
"Complications"
"Extradural haematomas are unilateral in more than 95% of cases, however, bilateral or multiple extradural haematomas are reported."
"The morphology of EDH is best understood by reviewing the anatomy of the calvarium and dura. An EDH is located on the inside of the skull, between the inner table of the skull and the parietal layer of the dura mater. As a result, extension is usually limited by the calvarial sutures; the periosteum exits through the suture and is continuous with the extracranial periosteal layer. This is resonsible for the distinguishing features of EDH; in contrast, subdural haematomas are not limited by sutures and spread more widely, adopting a crescentic shape."
"The morphology of EDH is best understood by reviewing the anatomy of the calvarium and dura. An EDH is located on the inside of the skull, between the inner table of the skull and the parietal layer of the dura mater. As a result, extension is usually limited by the calvarial sutures; the periosteum exits through the suture and is continuous with the extracranial periosteal layer. This is resonsible for the distinguishing features of EDH; in contrast, subdural haematomas are not limited by sutures and spread more widely, adopting a crescentic shape."
"EDH can cross venous sinuses and displace them from the skull where they deviate from sutures; venous sinuses are located between the parietal and visceral layers of the dura."
"Venous EDH can bleed copiously during surgery; preoperative recognition and planning are important to mitigate the risks."
"usually remote from the fracture (e.g. parafalcine)"