Extradural hemorrhage (summary)

Last revised by Candace Makeda Moore on 24 Sep 2019
This is a basic article for medical students and other non-radiologists

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

The bleed in relation to the dura mater is the key anatomical difference between an extradural and a subdural hemorrhage. As a student, a helpful tip is to remember that the dura tightly adheres to the intracranial bony sutures. Thus, an extradural hemorrhage is confined within that space, often producing a biconvex (also called lentiform) shape on CT.

Reference article

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

  • anatomy
  • epidemiology
    • young patients
    • high-energy impact trauma
  • presentation
    • headache (may be due to associated fracture)
    • localizing signs secondary to mass effect
    • loss of consciousness
  • pathophysiology
    • source of hemorrhage tends to be arterial
    • associated skull fracture
    • middle meningeal artery is particularly at risk
  • investigation
    • CT head (non-contrast) is quick, easy and readily available
  • treatment
    • urgent consideration of neurosurgical intervention
    • surgical treatment: evacuation of clot through a burr hole
    • smaller bleeds may be managed conservatively
  • role of imaging
    • initial diagnosis
    • determine of associated injuries and sequela
    • determine the underlying cause
    • determine further imaging and follow up
  • radiographic features
    • CT
      • peripheral hyperdense biconvex extra-axial collection
        • looking like a lens (lentiform) or egg ("eggs"-tradural)
      • well-demarcated hemorrhage between brain and skull
        • acute: hyperdense
        • active bleeding: central dark areas
      • bound by skull sutures
      • associated injuries, e.g. fracture, parenchymal contusion
      • sequelae, e.g. mass effect and midline shift

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Cases and figures

  • Figure 1: intracranial hemorrhage
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  • Case 1: extradural hemorrhage (huge)
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  • Case 2: extradural hematoma
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  • Case 3: extradural hematoma with conservative management
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  • Case 4: extradural hematoma
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  • Cae 5: epidural hematoma
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