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Extradural Haemorrhage - Medical Negligence Lawyers

An Extradural haemorrhage is also called an epidural haematoma or an extradural haematoma. It occurs when there is bleeding between the outer covering of the brain and the inside of the skull. The outer covering of the brain is called the “dura”. It is often caused by a skull injury causing a skull fracture in children or in adolescents. Older people tend not to get this type of bleeding as much because the dura is more closely attached to the skull than in younger people.

An extradural bleed is usually from a ruptured artery and is the result of having had a severe head trauma, such as occurs in motor vehicle or motorcycle accidents. You can also get venous bleeding (from a ruptured vein) in younger children.

Bleeding from an extradural haemorrhage is usually very rapid so that blood collects and pools in an area that presses upon the brain. Such pressure can destroy brain cells and cause brain damage. In fact, permanent brain damage can result unless the extradural bleeding is treated as a vital emergency. Death can occur within minutes to a couple of hours.

Brain haemorrhage claim solicitors deal with applications for awards of damages for personal injury on the basis of medical negligence following either miss-diagnosis or failed surgical intervention both of which can cause a worsening of the initial problem.

Symptoms

Initial symptoms of an extradural haematoma include dizziness, confusion, altered level of consciousness, severe headache, enlarged pupil on one side of the body, head injury with rapid loss of consciousness or rapid deterioration in functioning, nausea, vomiting and weakness. The symptoms happen within a few minutes to an hour after a head injury and represent a true medical emergency. A typical pattern involves a sudden loss of consciousness after the injury, followed by some form of alertness and then loss of consciousness again.

Brain haemorrhage claim solicitors often deal with cases where a patient in the early stages of a brain haemorrhage presents at hospital suffering from severe headache to be told to go home and take analgaesics. Within a few hours the patient is unconscious, often with little chance of full recovery which may have taken place with early surgical intervention. This scenario may be determined to be an issue of medical negligence leading to an award of damages for pain and suffering and financial losses.

Testing & Diagnosis

A complete neurological examination can show multiple deficits or evidence of an increased intracranial pressure. One pupil is often much larger than the other. Time should not be wasted on any other testing, with the exception of a CT scan of the head, which should show the area of bleeding. It should be reserved, however, in relatively stable patients who can afford to wait for surgery or if the surgeon has not yet arrived.

Treatment

Because an extradural haematoma is an emergency condition, there should be prompt referral to a neurosurgeon who can open the brain up at the specified area and can allow the blood and hematoma to drain or be removed. The bleeding site must be repaired so no further bleeding happens. Larger haematomas need to be removed via a craniotomy, which is a larger window open in the skull itself.

The individual will need life support in the form of intubation and IV therapy. Medications such as mannitol are used to decrease intracranial pressure. Steroids are also used to reduce inflammation in the brain. These are both given by IV in high doses. Dilantin (phenytoin) is used to control seizures and may need to be used for some time.

Prognosis

The prognosis of an epidural haemorrhage is poor, with many people dying if they don’t have prompt neurosurgical intervention. Even in cases of prompt medical attention, there is a high risk of disability or death following this type of injury.

Complications

Permanent brain damage is a complication of an epidural haematoma. Seizures can persist for several months and can begin as many as two years after the injury. Children recover faster than adults but incomplete recovery is commonplace. Adults recover within 6 months and reach their maximal potential after about 2 years. Other complications include brain herniation and death or permanent coma, and a condition called normal pressure hydrocephalus.

Medical Negligence Solicitors

Our brain haemorrhage claim solicitors deal with legal action for medical negligence using the no win no fee scheme. If you have been injured by a healthcare professional including a doctor, dentist, nurse or technician and would like to speak to a medical negligence lawyer without further obligation, just use the helpline. An Extradural Haemorrhage medical negligence lawyer who deals exclusively in personal injury claims will speak to you, giving free advice and information on how best to preserve your legal right to receive compensation as a result of injuries caused by medical negligence.

Our Extradural Haemorrhage medical negligence lawyers have solicitors offices situated in Adelaide, Canberra, Melbourne, Perth, Sydney, Brisbane and Darwin.

Extradural Haemorrhage Overview

An extradural brain haemorrhage involves bleeding outside of the outer covering of the brain, the dura, and the skull itself. It is a condition caused by a skull fracture that happens to kids in childhood or adolescence. The reason it is more common in young people is because the dura is not so firmly attached to the person’s skull as it is in people who are older.

Usually, the skull fracture ruptures an artery near the dura mater, which causes bleeding in the area described above. One or several arteries can be torn by the skull fracture.

An extradural haemorrhage is usually the result of a serious head injury—one that is caused by an automobile or motorcycle accident. In very young kids, the bleed is venous and not arterial but can still be severe bleeding.

The rapid nature of the bleeding causes a large collection of blood (known as a haematoma) which presses on the brain. This can cause further brain injury and the pressure can cause the brain to herniate through the hole at the base of the brain (the foramen magnum). This results in a lack of spontaneous breathing, cardiac arrest and death.

This is considered a medical emergency because brain damage is likely if the haemorrhage is not treated promptly. If not treated at all, the outcome is death. The person rapidly worsens over several minutes to hours. They progress from drowsiness to developing a coma to sudden death fairly rapidly.

The bleeding source is usually a ruptured meningeal artery—usually the middle meningeal artery. In about 80 percent of cases, there is an associated skull fracture. Headache is related to the stripping of the dura away from the bone and the increasing size of the haemorrhage. About 5-10 percent of cases involve a haemorrhage in the posterior fossa of the skull. The extradural haematoma is usually unilateral (in 95 percent of cases). Ninety to ninety five percent are supratentorial; 60 percent are temporoparietal; 20 percent are frontal; 20 percent are parieto-occipital; 5-10 percent are infratentorial and located in the posterior fossa.

Because of the rapidity of this disorder, a health professional should look after anyone with a head injury that involved even a brief loss of consciousness or if other symptoms occur after a head injury, even if loss of consciousness did not occur.

Usually, with an extradural haemorrhage, there is loss of consciousness and then a period of alertness followed by another loss of consciousness. This might not happen in everyone, however.

Common symptoms to pay attention to in an extradural haemorrhage include:

  • Dizziness
  • Confusion
  • Decreased level of consciousness
  • Drowsiness
  • Different sized pupils with one being very large
  • Severe headache
  • Head injury with loss of consciousness, alertness and then loss of consciousness
  • Weakness of half the body
  • Nausea and vomiting

These symptoms tend to occur within minutes of the injury and it is usually clear that the individual is suffering from a medical emergency.

The exams and tests used to diagnose extradural haemorrhages involve first doing a neurological exam that may show the part of the brain involved; it will also reveal evidence of increased intracranial pressure. If there is evidence of intracranial pressure increase, patient needs emergency surgery in order to relieve the pressure. This helps make sure that there is no further brain injury either.

If there is time, a head CT scan can be done, which will show the skull fracture, show that it is in fact an extradural hematoma, and will show the exact location of the bleed. A CT is the preferred test because it easily shows extradural haematomas. They are seen as convex areas of bleeding just beneath the squamous aspect of the temporal bone. There may be a secondary mass effect such as a shift of the brain from the midline, an uncal herniation or a subfalcine herniation.

If the bleeding is active when the CT scan is done, there may be hyper dense, non-clotted blood seen along with a swirl effect. Because of the type of bleed it is, it is stopped by the sutures of the skull, which differentiates it from a subdural haematoma, which is not limited by the suture lines of the skull. The extradural haematoma does cross the venous sinuses and will raise them up. The bleed can cross a suture line only if there is a fracture that causes diastasis of a nearby suture, rupturing the dura.

An MRI can be done, showing the displacement of the dura which looks hypo-dense as opposed to how it looks on a subdural haematoma. IV contrast can be done on both CT scans and MRI scans and will help define the areas of bleeding.

The treatment of extradural haemorrhage is an emergency. The hope of the emergency team is to first save the individual’s life, keep symptoms at a minimum, and minimize the long term sequelae that can happen with this kind of injury. The person may need life support measures along with emergency surgery designed to reduce the amount of pressure within the brain. In its most basic of procedures, emergency personnel can drill a burr hole into the skull to allow the blood to escape and to decrease the pressure on the brain. Sometimes large blood clots need to be removed through a larger hole called a craniotomy.

Some patients need medications like phenytoin to block seizures while others will receive medications like mannitol, which is a hyperosmotic agent that reduces swelling on the brain.

The prognosis of having an extradural haematoma is poor if the person doesn’t have prompt surgery and this means that these people generally die without intervention. The risk of disability and death remains high even if everything was done as promptly as possible.

Possible complications include permanent injury to the brain, even if the haemorrhage was appropriately treated. Seizures can last for several months but eventually fade off and disappear. There may be as many as two years past before the seizures start.

The most recovery occurs within the first six months with residual improvement lasting about two years. Children with an extradural hemorrhage tend to do better than adults.

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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here