Extradural hematoma with cerebral compression is one of the most urgent of all surgical emergencies, Treated on time, the patient can make a full recovery. Failure to diagnose and operate will definitely lead t death. This is one of the direst o of all neurosurgical emergencies. The signs and symptoms of an extradural hematoma and its natural progress are well documented in the Textbook of Neurosurgery A few points are worth stressing. The classic lucid interval is not often seen. The original injury would have caused damage to other parts of the brain and the clinical picture may be confusing. The level of consciousness and pupillary dilatation, if any, are the main signs to be observed. Some patients may not have any neurological deficit, but continue to be restless and have severe headache. This should alert the surgeon to the presence of an extradural hematoma Usually, because of the increasing intracranial pressure, the blood pressure tends to be high in patients with extradural hematoma. On the contrary, if the blood pressure is low, loss of blood during the accident or an interval hemorrhage has to be suspected Head injuries are frequently accompanied by cervical injuries. Every patient with a head injury has to be examined for cervical spine injury. If such a patient develops an extradural hematoma, great care is to be taken when shifting the patient and during intubation. A cervical collar and, if necessary, cervical traction have to be in position
all the time
