Extradural haematoma: hyperacute

Case contributed by A.Prof Frank Gaillard

Presentation

Pedestrian hit by vehicle.

Patient Data

Age: 20 years
Gender: Female

A 2.5 cm thick biconvex extra-axial collection overlying the right temporoparietal lobe is predominantly isodense but contains streaky high density material within in a horizontal orientation emanating from the expected location of the middle meningeal artery. There is mass-effect with compression of the right temporal lobe, sulcal effacement in the right cerebral hemisphere, 9 mm midline shift to the left, mild compression of the right lateral ventricle and right-sided sub falcine herniation. Small foci high attenuation in the right temporal lobe are suspicious for small petechial haemorrhages as well as subarachnoid haemorrhages.

No skull vault or skull base fracture is seen, but there is a scalp haematoma and wound overlying the right skull.

Case Discussion

It is important to remember that hyperacute haemorrhage is isodense to intravascular blood. In this case there are areas of clot retraction anteriorly. Other causes of a swirled or low density extradural haematoma are presence of dural tear with admixing of CSF with blood, anticoagulats, and low hematocrit. 
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Case information

rID: 26035
Case created: 24th Nov 2013
Last edited: 1st Nov 2015
Inclusion in quiz mode: Included

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