AN UNUSUAL CASE OF EXTRA‐DURAL HAEMATOMA.

Abstract

classical clinical picture of extra‐dural terval, deteriorating consciousness, pupillary changes, developing hemiplegia, falling pulse rate and rising blood pressure ‐ has often been described, and is stressed to the student as his criterion for the diagnosis of this dramatic and, in its early stages, remediable sequel of head injury. But this condition may masquerade in various disguises, and the differential diagnosis from cerebral vas‐ cular accident, in particular, is often beset with difficulty. THE haematoma‐of head injury, lucid in‐ Lumbar puncture was performed, lightly blood‐ stained cerebrospinal fluid being obtained under a pressure of 205 millimetres of cerebrospinal fluid. Microscopy showed 1,400 erythrocytes and 4 lympho‐ cytes per cubic millimetre. A provisional diagnosis was made of subarachnoid haemorrhage resulting from leaking of an intra‐ cranial aneurysm ‐ probably situated on the right posterior communicating artery ‐ and on the next day percutaneous right carotid angiography under local anaesthesia was attempted ‐without success, owing to failure to puncture the exceedingly mobile artery. This case is recorded because of its interesting clinical and radiological features. Summary An unusual case of post‐traumatic extra‐dural haematoma is reported. There was no history of injury, and the case clini‐ cally resembled intracranial aneurysm. The angiographic picture of extra‐dural haematoma is presented, with demonstra‐ tion of the bleeding point. The‐necessity for early establishment of diagnosis, and for early operative inter‐vention is stressed.