ICU Cases · Raised ICP & TBI
Acute extradural haematoma — the lucid interval and the surgical emergency
A short case on a classic neurosurgical emergency — the extradural (epidural) haematoma with its lucid interval. Tests recognition of the syndrome, the CT appearances, the pathophysiology of transtentorial herniation, and the principle that evacuation is the only definitive treatment.
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A 19-year-old man fell from a ladder and was briefly unconscious. By time ambulance arrived he had recovered and was talking normally; on arrival in the emergency department, an hour later, he was again becoming drowsy and confused. He now complains of a severe headache and has vomited once.[1]
On examination: his Glasgow Coma Scale is 13 (E3 V4 M6) and falling, his right pupil is 6 mm and unreactive while the left is 3 mm and reactive, and he has a weak left side. His blood pressure is 160/95, his pulse is 56, and his respiratory rate is irregular.[1]
References3ShowHide
- [1]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [2]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.
- [3]Carney N, Totten AM, O'Reilly C, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery, 2017.PMID 27654000