Extra-dural Haematoma

This is a neurosurgical emergency! Collection of blood within the inner table of the skull and that of the epidural space.

In general the rupture of the middle meningeal artery (anterior branch) at the Pterion.

The Middle Meningeal Artery is a branch of the Maxillary Artery from the terminal branch of the External Carotid Artery.

Note Posterior Extra-Dural Haematoma’s is due to rupture of the dural venous sinus and is generally managed conservatively due to the operative risk of haemorrhage.

The Pterion is the confluence of the following bones:

Squamous Temporal Bone

Frontal Bone

Parietal Bone

Greater Wing of Sphenoid


Classical Presentation

Head injury-  with associated Lucid Interval. Not always the case as these patients are often found unconscious!

False Localising Signs (see Intra-Cranial Herniation)

3rd Nerve Palsy- raised intra-cranial pressure

Ipsilateral Weakness- Kernohan’s Phenomenon indicates raised intra-cranial pressure.

CT Scan

Classically lentiform shaped lesion, compared to the cresenteric shaped subdural haematoma.



  1. Small Extra-Dural Haematoma’s can be managed conservatively with a short course of Steroids with a PPI
  2. The large majority of the extra-dural’s are managed surgically via clot evacuation (craniotomy). To prevent re-bleeding the dura is ‘hitched’ to the inner table of the skull.