PROGRESSIVE EXTRADURAL HAEMATOMA AND ITS CLINICAL FEATURES

ABSTRACT
Introduction: Progressive extradural haematoma is a unique entity by virtue of its evolution over time. The current
radiologic and neurointerventional development are the key factors which have contributed to the identification of this
new entity among the head injured patients. Factors which might be related to its incidence are important for timely
diagnosis and intervention.
Objective: The aim of this study is to identify the factors which predict the incidence of progressive extradural haema-
toma in adult head injury patients.
Methods: This is a retrospective chart review study, conducted at the department of neurosurgery, Hayatabad Med-
ical Institute Peshawar between January and December 2015. Patients who were admitted with head injury and who
later progressed to increase in the volume of epidural haematoma on follow-up CT during the same admission were
included. Data was collected about patient demographics, arrival GCS, laboratory and clinical findings such as systolic
BP at presentation, pupillary abnormalities, coagulation profile, platelet counts, comorbidities and CT findings such as
initial and final volume of epidural hematoma. Patients who were not candidates for surgical evacuation on follow-up
CT were excluded.
Results: Overall mean age was 33.79 ± 11.41 years, mean arrival GCS was 10.86 ± 2.45 (median: 11), mean systolic
BP was 114.28 ± 18.41 mm of Hg, mean time since injury was 7.59 ± 3.93 hours, mean platelets count was 217 x 103
± 119 x 103
. The mean INR was 1.25 ± 6.3. Overall mean volume at the first CT was 11.78 ± 6.3 mm3
 (range: 0 – 23
cc). Similarly, mean volume at the follow-up CT was 43.14 ± 10.16 mm3
 (range: 26 – 60 cc) with a mean time between
the two scans of 15.28 ± 9.27 hours (range: 4 – 48 hours). The mean GCS at discharge was 12.3 ± 3.5 (median: 13.5).
Conclusion: Outcome in progressive extradural haematoma is affected by age, arrival GCS, systolic BP and the vol-
ume at the time of surgery. The time since injury, coagulation profile, platelets count and the volume at first CT is not
associated with the outcome.
Keywords: Head Injury, Traumatic Brain Injury, Progressive Extradural Haematoma.