Extradural haematoma : non surgical management

Nine patients with traumatic epidural haematoma (EDH) have been reported and literature reviewed. Drowsiness was present in 5, dullness in 3 and papilloedema in 2 cases. Four patients had hemiparesis. The thickness of the haematoma was 1.6 cms in one and 4.3 cms in another while in the rest it was 1.6 cms or less. Patients with minor head injury (Glasgow Coma Score [GCS] 13-15) with mild clinical symptoms in static or recovery phase and minimal signs presenting late after 36 hours of injury, where CT scan reveals diffuse haematoma (rather than localised one indenting on the brain) of thickness less than 1.5 cms without midline shift may be managed without surgical intervention only if facilities for close observation are available. Surgical evacuation is the gold standard for all extradural haematomas when there is any doubt.