Q: What examination and investigations are important to perform here? show answer
Q: What changes might you see on neurological examination? show answer
Fall from about 3m. No limb or chest injuries. Witnessed to hit head, confused.
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Large right sided bi-convex (or lenticular) collection under the skull. It is hyperdense in comparison to surround brain tissue/parenchyma.
On this slice, there is midline shift with compression of the lateral ventricles.
There is also marked soft tissue swelling over the skull on the right side.
Using the bony window, there is a depressed, comminuted skull fracture overlying the area we know the collection is in.
This case is a good example of extradural haemorrhage.
These usually occur after trauma (head injury). When the skull is fractured in high-energy injury, it can lead to tearing of the arteries sitting underneath the bone but above the dura.
It is important to get these bleeds quickly recognised and controlled, usually under direct neurosurgical care. There can be a "lucid interval" as the brains in these young patients can cope with the increased pressure from a bleed before deteriorating rapidly. There is also high risk of infection as these are usually open fractures.
CT is the method for imaging in these events as it is quick, widely available and can show bleeds and bone injuries well.
This case was contributed to Radiopaedia.org by Dr Sandeep Bhuta and the original can be viewed here. Note: patient presentation added to act as a teaching tool for EDH.
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