Extradural haemorrhage (summary)

Dr Derek Smith et al.

Extradural haemorrhages (EDH) represent collections of blood in the extradural (epidural) space. The haemorrhage sits between the skull superficially and the dura which overlies the brain parenchyma.

Reference article

This is a summary article; read more in our article on extradural haemorrhage.

  • epidemiology
    • young patients
    • high-energy impact trauma
  • presentation
    • a headache (may be due to associated fracture)
    • localising signs secondary to mass effect
    • loss of consciousness
  • pathophysiology
    • the source of haemorrhage tends to be arterial
    • associated skull fracture
    • the middle meningeal artery is particularly at risk
  • investigation
    • non-contrast CT head is quick and readily accessible
  • treatment
    • urgent consideration of neurosurgical intervention
    • surgical treatment: evacuation of clot through a burr hole
    • smaller bleeds may be managed conservatively
  • initial diagnosis
  • assessment of associated mass effect
  • assessment of associated injuries, e.g. skull fracture
  • look for an underlying cause
  • suggest further imaging
  • follow up

Non-contrast CT is the imaging modality of choice for the investigation because it is highly sensitive for haemorrhage and fracture. Moreover, it is quick and highly available and is the safest option for a potentially sick patient.

CT

Extradural haematomas will be seen peripherally as a biconvex area of hyperdensity. This has been described as looking like a lens (lentiform) or an egg ("eggs"-tradural haemorrhage). The haemorrhage is well demarcated as it sits between the skull and brain parenchyma and does not cross the skull sutures.

They tend to be hyperdense (bright). However, active haemorrhage will be seen as an area of hypodensity (the non-clotted blood appears dark within the rest of the clotted haematoma).

CT may illustrate skull fractures or other parenchymal injuries. If the haemorrhage is of sufficient size, mass effect may be seen, e.g. midline shift, herniation.


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Article Information

rID: 32666
Synonyms or Alternate Spellings:
  • EDH (summary)
  • epidural haemorrhage (summary)
  • extradural haematoma (summary)

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Cases and Figures

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    Figure 1: intracranial haemorrhage
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    Case 1: extradural haemorrhage (huge)
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    CT
    Case 2: extradural haematoma
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    EDH
    Case 3: extradural haematoma with conservative management
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    Case 4: extradural haematoma
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    Cae 5: epidural haematoma
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