Published: 2017-03-28

A study on various clinical presentations of extradural hemorrhage, factors affecting treatment and early outcome

Ch. Surendra Kumar, K. Satyavara Prasad, B. Rajasekhar, B. V. S. Raman


Background: In India 11% of deaths are due to trauma and 78% of injury deaths are due to head injury. The aim of this study was to analyse the clinical spectrum and to evaluate the postoperative outcome in patients with head injury with an extradural hematoma.

Methods: This was a retrospective observational study which included 100 patients admitted in King George hospital, Andhra medical college, Visakhapatnam, Andhra Pradesh, India over the past two years (01/10/2014 to 30/09/2016) with head injury, diagnosed to have traumatic extradural hemorrhage. A detailed clinical history, physical examination and CT scan was performed in all patients. For patients who were subjected to surgery operative and post-operative findings were noted.

Results: The maximum patients suffering from EDH are in the age group of 21-30 years (28%) with male predominance (95%). The most common mode of injury is RTA (58%) under the influence of alcohol. Majority of cases reached hospital within 6 hours fromĀ  time of injury (44%). 95% of patients with EDH presented with LOC followed by vomiting in 68% of cases, followed by Headache in 42% of cases. 53% of the cases presented with mass effect over brain parenchyma with frontal EDH as most common location. Out of 100 cases, surgical approach was considered in 57 patients while remaining 47 patients were managed conservatively. Recovery from clinical and functional morbidity was satisfactorily acceptable, following treatment.

Conclusions: Early presentation with mild to moderate GCS has good clinical outcome with minimal disability.


Epidural hematoma, Glasgow coma scale, Loss of consciousness

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Khan MJ, Shaukat A, Khalid M, Aziz MA. Surgical management and outcome analysis of extradural hematoma at combined military hospital Rawalpindi. Pakistan Armed Forces Med J. 2009;59(1):1-4.

Taussky P, Widmer HR, Takala F, Fandino F. Outcome after acute traumatic subdural and epidural haematoma in Switzerland: a single centre experience. 2008;138;281-5.

Yurt I, Bezircioglu H, Ersahin Y, Demircivi F, Kahraman M, Tektas S. Extradural haematoma: analysis of 190 Cases. Turkish Neurosurg. 1996;6:63-7.

Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of acute epidural haematomas. Neurosurgery. 2006;58:52-7.

Pozzati E, Frank F, Frank G, Gaist G. Subacute and chronic EDH, A study of 30 cases. J Trauma. 1980; 20(9):795-9.

Babu MI, Bhasin SK, Kumar A. Extradural hematoma- an experience of 300 cases. JK Science 2005;7:205-7.

Husain M, Ojha BK, Chandra A, Singh A, Singh G, Chugh A, Rastogi M, Singh K. Contralateral motor deficit in extradural hematoma: Analysis of 35 patients. Indian J Neurotrauma. 2007;4(1):41-44.

Hutchinson J. Effusion of blood between bone and duramater. Lond Hosp Rep. 1867;4:51.

Cheung PS, Lam JM, Yeung JH, Graham CA, Rainer TH. Outcome of traumatic extradural haematoma in Hong Kong. Injury. 2007;38:76-80.

Agrawal A, Agrawal CS, Kumar A, Adhikari S. Outcome of traumatic extradural haematoma managed surgically: our experience. Nigerian J Ortho Trauma. 2007;6(2):74-6.

Paterniti S, Fiore P, Macri E, Marra G, Cambria M, Falcone F, Cambria S. Extradural haematoma report of 37 consecutive cases with survival. Acta Neurochir (Wien). 1994;131:207-10.

Bricolo AP, Pasut LM. Extradural hematoma: toward zero mortality- prospective study. Neurosurgery. 1984;14:8-12.

Lobato RD, Rivas JJ, Cordobes F, Alted E, Perez C, Sarabia R, et al. Acute epidural hematoma: an analysis of factors influencing the outcome of patients undergoing surgery in coma. J Neurosurg. 1988;68:48-57.

Dubey A, Pillai SV, Sastry KVR. Does volume of extradural hematoma influence management strategy and outcome? Neurol India. 2004;52:443-5.

Mishra A, Mohanty S. (2201). Contre-coup extradural haematoma. A short report. Neurol India. 2001;49(1):94-5.

Cook RJ, Dorsch NW, Fearnside MR, Chaseling R. Outcome prediction in EDH. Actaneurochir (Wein). 1988;95(3-4):90-4.

Saxena RC, Bilodi AKS, Mane SS, Kumar A. Study of pterion in skulls of awadh area-in around Lucknow. Kathmandu Univ Med J. 2003;1(1):32-3.

Iqbal Z, Arshad M, Yasin M. Acute traumatic extradural hematoma-A study of 80 cases. Pak J Neurol. 1999:5:36-40.

Kalayanaraman S, Ramamurthi K, Ramamurthi B. Analysis of 2000 cases of head injury. Neurology India 1970;18:3-11.

Jamesson KG. Extradural and subdural haematoma, changing pattern and requirement of treatment in Australia. J Neurol. 1970;33:632.

Baykaner K, Alp H, Ceviker N. Observations of 95 patients with extradural haematoma and review of literature. Surg Neurol. 1988;30:339.

Metellus P, Dufour H, Mauera L, Fueufes S. Spontaneous Vertex EDH: Considerations about causes, case report and review of literature. J Neurosurg. 2001;94(4):633-6.

Carrroll TA, Smith K, Jaubowski J. Extradural haematoma following temporomandibular joint arthrocentesis and lavage. Br J Neurosurg. 2000;14(2):152-4.

Bae DH, Choi KS, Yi HJ, Chun HJ, Ko Y, Bak KH. Cerebral infarction after traumatic brain injury: incidence and risk factors. Korean J Neurotrauma. 2014;10:35-40.