Extradural hemorrhage | Radiology Case

Extradural hemorrhage | Radiology Case

30 year-old-male with head trauma. GCS 7.

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Observation and interpretation

  • Acute bi-convex extradural hematoma in right frontal region (yellow arrow). Mass effect causing effacement of adjacent sulci and frontal horn of right lateral ventricle.
  • Few hemorrhagic contusions with vasogenic edema in left frontotemporal regions (red arrows).
  • Fracture of frontal bone on right side extending into right parietal bone (white arrows).
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Principal Diagnosis

Extradural hemorrhage with skull fracture and contusions

Differential Diagnosis

Subdural hematoma

  • concavo-convex in shape or crescent shaped
  • it can cross suture lines
  • caused by tear of bridging cortical veins

Further Management

  • Urgent neuro-surgical referral for surgical evaluation of the hematoma.

Teaching Points

  • Extradural or epidural hematoma is a blood collection between the skull and the dura.
  • It is associated with head injury and is often caused by tear of the middle meningeal artery.
  • It is lentiform or bi-convex in shape and doesn’t cross cranial sutures.
  • Majority are supratentorial in location.
  • It may cause significant mass effect when large. Such a large hematoma is a surgical emergency due to mass effect and herniation risk, small ones can be managed conservatively with follow-up imaging.
  • Venous epidural hematomas are less common, caused by dural sinus laceration.
Shape

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