Experience With Extradural Haematomas in New South Wales

Abstract

A retrospective study of 126 patients with extradural haematomas was made to determine whether their outcome could be modified by alteration of their management. Poor outcome occurred in those over 65 years of age, in motor smash victims, in those with fixed pupils, in those with major associated injuries or those comatose on hospital admission. The detection of skull fracture or of a lucid interval was not prognostically useful. A graduation in mortality according to the type of hospital was present but did not reach statistical significance. Failure to correct shock and delay in instituting definitive treatment were the major preventable factors which could be modified to improve outcome.

Prognostic factors in severely head injured adult patients with epidural haematoma's

“…The mortality of such cases (now ranging from 15 to 24%) with the diffusion of CT scanners should be close to 0. Unfortunately this is not the case: mortality and morbidity in the last years did not improve dramatically [35,40]: it was from 33% to 54% in studies of the preCT era [10, 13,14,24] and it is from 14% to 41% (excluding patients travelling long distances as in Dan et al [8]) in the CT era ( Table 2). Resources of additional CT scans in periferal hospitals are unfortunately not directed at the head injury population.…”

“…In two reports no significant relationship between age and outcome was found [19,35]. Epidural haematoma's are uncommon in elderly patients [10] because of the strong adherence of the dura to the inner skull, Published casistics seldom contain more than 10% of patients aged over 50 years [1,7,8,23] and the lack of statistical significance of the association between age and outcome for evacuated epidural haematoma's is probably due to the small number of elderly patients [23]. No statistically significant difference concerning age was found between immediately comatose patients and those with a lucid interval [36].…”

Hematoma extradural intracraniano

“…Ao exame físico, os pacientes podem apresentar bradicardia ou hipertensão, indicando hipertensão intracraniana, fraturas ósseas no crânio, hematomas, lacerações, drenagem de líquido cerebroespinhal pelo ouvido ou nariz, como resultado de laceração na dura-máter, hemotímpano, instabilidade da coluna vertebral, alteração do nível de consciência aferida pela ECG, anisocoria, paralisia facial, hemiparesia ou hemiplegia e outros défi cits neurológicos focais 3,6,8,12,14,16,22,29,37,39,42,47,48,77,78,85,93 .…”

“…tábua interna do osso 6 .Apesar da aderência ser maior nas margens de suturas entre os ossos, grandes áreas podem ser descoladas até que o sangramento seja contido. Algumas evidências demonstram que o HED não se expande indefi nidamente devido ao fato de o vaso sangrante ser tamponado pela pressão exercida pelo hematoma 22 . Diante disso, a maioria dos HED são lesões estáveis no momento do diagnóstico.…”

Damage control in the injured patient

“…[7778] Optimizing the general condition of the patient is essential in optimizing outcomes from head injury. Damage control neurosurgery involves rapid arrest of intracranial bleeding, the evacuation of intracranial hematomas and the early debridement of compound wounds to the skull.…”