Extradural haematoma

An extradural haematoma is formed when the inner layer of dura is stripped from the skull, with tearing of the meningeal artery, as a result of deformation or fracture of the skull. Seventy per cent of such haematomas occur in the temporal or parietal regions, as this is where the fracture crosses the path of the middle meningeal artery. Ten per cent occur in less obvious locations, such as the posterior fossa, where the fracture tears the sinus producing a venous haemorrhage, or the frontal region, from a small meningeal arterial haemorrhage. The clinical presentation may be abrupt in the former instance, associated with sudden loss of consciousness and respiratory arrest, or in the latter, insidious over 72 hours. One in five patients present with a "lucid interval", that is, improvement in conscious level following a TBI severe enough to cause concussion. Early surgical evacuation generally leads to a good recovery (Figure 2.1a).

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