EDH Optek Penugasan ilmiah Number 2.pptx

Penugasan ilmiah EDH

1. EPIDURAL HAEMATOMA Nuraga Wishnu Putra dr. Grace E.P.M. Sianturi, SpBS

2. Pathophysiology

3. Clinical presentation Kristiansen and tandon in 1960 described that the patients with EDH may have the following five clinical presentations :- Concious throughout 8 % - 24 % Unconcious throughout 23 %- 24 % Initially concious and subsequently unconcious 20 %- 28 % Initially unconcious and subsequently lucid 14 % - 21 % The “textbook” presentation of brief traumatic loss of conciousness LOC followed by lucid interval for several hours and then obtundation,contralateral hemiparesis and ipsilateral pupilliary dilatation occurs in less than 10 – 27 % of the patient

4. Lucid interval An epidural hemorrhage is often characterized by the following sequence of events: Blunt trauma/ a blow to the head, followed by: 1) Initial confusion, decreased consciousness, or loss of consciousness 2) A “lucid interval” (20-50%): a brief period of full conciousness /restored mental status. The patient seems back to his/her “normal self.” 3) Change in mental status +/- unstable vital signs (blood pressure, heart rate): the patient becomes confused, somnolent (sleepy), may have neurologic signs such as hemiparesis, one dilated pupil, may become comatose.

5. Diagnosis The diagnosis of EDH must be considered when the plain skull xrays show a fracture and it must be clinically corelated If the clinical condition of the patient permits and a non contrast computed tomogram is possible,it must be done urgently The classic CT appearance is seen in 84 % of the cases and shows hyperdense ,biconvex The derivation of the  ABC /2 formula is as follows: The volume of an ellipsoid is 4/3π( A /2)( B /2)( C /2), where  A ,  B , and  C  are the three diameters. If π is estimated to be 3, then the volume of an ellipsoid becomes  ABC /2.

6. Generally EDH is confined within the sutures but this may not be the case everytime , occasionally, air may be seen within the haematoma due to an associated internal or external compound fracture of the skull. MRI can also be done but it is in no way superior to CT and also time consuming .

7. Post.fossa saggital c+ arterial phase

8. In a rapidly deteriorating patient with suspected EDH ,a CT scan is inappropriate. The clinical triad of : Is often due to upper brainstem compression by uncal herniation which in majority of the trauma cases is due to EDH. In such patients, exploratory burr holes are indicated

9. Nonsurgically with serial CTscans and close neurological observation in a neurosurgical center: a) volume <30 cm3 b) and thickness <15 mm c) and with midline shift (MLS) <5 mm (p. 921) d) and GCS>8 e) and no focal neurologic deficit

10. Dural Hitch Suture

11. MORBIDITY AND MORTALITY DELAY IN THE DIAGNOSIS AND TREATMENT IS THE MOST COMMON PREVENTABLE CAUSE OF MORBIDITY AND MORTALITY . RECURRENT OR RESIDUAL HAEMATOMA MAY RESULT FROM THE FAILURE TO GAIN FULL ACCESS TO HAEMATOMA AND TO THE LACERATED MENINGEAL VESSELS OR MULTIPLE SMALL BLEEDERS ON THE DURA WHERE IT HAS BEEN STRIPPED OFF THE INNER TABLE OF THE SKULL

12. MORTALITY FOLLOWING TREATMENT OF EDH VARIES FROM 5% TO 43 %. IN CHILDREN 5%- 10 % INCREASES SHARPLY IN THOSE OVER 40 YEARS 35% - 50 % OLDER AGE,POOR PREOPERATIVE NEUROLOGICAL CONDITION ,LARGE HAEMATOMA VOLUME ,DELAY IN OPERATIVE EVACUATION ,LARGE MIDLINE SHIFT AND POST OPERATIVE ELEVATION IN ICP ARE ALL ASSOCIATED WITH POOR PROGNOSIS

13. EPIDURAL HAEMATOMA Nuraga Wishnu Putra dr. Grace E.P.M. Sianturi, SpBS