Extradural hematoma

Case contributed by Dr Andrew Dixon

Presentation

Head trauma

Patient Data

Age: 60 years
Gender: Male

This case featured in our 2016 Trauma Radiology Course which is now available to view online.

CT

CT Brain

Very large left sided extradural hematoma which underlies the parietal bone and the occipital bone with fracture diastasis of the left lambdoid suture. The hemorrhage therefore has both supratentorial and infratentorial extension pushing the origin of the tentorium inward. There is marked midline shift to the right and compression of the midbrain due to uncal herniation. Hemorrhage within the markedly effaced and displaced left lateral ventricle. The left cerebellar tonsil descends through the foramen magnum without causing compression of the cervicomedullary junction. Several small left cerebral / basal ganglia intraparenchymal hemorrhages are seen. Swirling low density within the generally hyperdense extradural collection is consistent with ongoing arterial bleeding. A left petrous temporal bone fracture is present, accounting for the locules of intracranial gas within the hematoma. 

Case Discussion

Large left sided extradural hematoma producing substantial mass effect with compression of the midbrain. While extradural hematoma do not often cross cranial sutures, they can if there is fracture disruption of the suture as in this case. This case also demonstrates nicely how extradural hemorrhage does not extend along dural reflections, but instead pushes the origin of the dural folds inward. 

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Case information

rID: 32391
Published: 25th Nov 2014
Last edited: 15th Aug 2018
Inclusion in quiz mode: Included

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