Extradural (epidural) haematoma - Head injury / traumatic brain injury
Introduction
An extradural haematoma (EDH, also called epidural haematoma) is an accumulation of blood between the inner table of the skull and the outer layer of the dura mater. It is classically arterial (most commonly from the middle meningeal artery) and can expand rapidly, causing raised intracranial pressure (ICP) and transtentorial herniation.
Prompt resuscitation, urgent non‑contrast CT head and early neurosurgical input are essential.
Use NICE Head injury: assessment and early management (NG232) as the primary framework for imaging and referral decisions, and NG39/NG40 for triage/destination decisions (major trauma and transfer to specialist centres). Follow RCEM transfer guidance for practical transfer logistics and Resuscitation Council UK guidance for airway, ventilation and post‑resuscitation care.
Epidemiology and aetiology
- Most EDHs follow blunt head trauma and are frequently associated with a skull fracture (seen in ~70-80% of cases).
- The pterion region is a common site of impact; the middle meningeal artery runs beneath it and is vulnerable to laceration.
- Bleeding usually creates a lens‑shaped (biconvex) collection that separates the dura from the skull and tends not to cross cranial sutures.
Clinical features
Presentation is variable; the “lucid interval” (brief unconsciousness, temporary recovery, then deterioration) is classical but not always present. Important features to recognise:
- Recent head trauma, often with a temporal/parietal impact and...