Picture quiz: Head injury and decreased consciousness
- By: Senthil K Selvanathan, Tony Goldschlager, Jeffrey V Rosenfeld, Rebecca D Udani, Sundip D Udani, Lisa M Jackson
A 32 year old woman was hit by a car. When the ambulance arrived she was awake and talking, but she seemed confused and said she had a headache. At the emergency department she was still confused and said she had a severe headache. No focal neurological deficits were detected. Radiography of the skull showed a left parietal fracture. Shortly after admission to the ward she vomited and her level of consciousness was recorded using the Glasgow coma scale and was found to be deteriorating. A right extensor plantar response was found on examination. An emergency computed tomogram was taken (fig 1).
Extradural haematomas are most commonly found over the temporal region followed by the frontal lobe. They can also occur in the parasagittal area and posterior fossa, but these are uncommon.
Extradural haematomas require urgent neurosurgery. An infusion of mannitol, an osmotic diuretic, or furosemide, a loop diuretic, may