Up to 90% of extradural haematomas are associated with skull fracture. Contusion and subdural haematoma may also be associated. The mechanism of injury is usually laceration of the meningeal artery or vein. The often quoted text book history of concussion followed by a lucent interval only occurs in about a third of patients. More common is somnolence 24 hours or more following the head injury. An extradural haematoma particularly with mass effect is a neurosurgical emergency. Clues for diagnosis on CT are

■ biconcave/lens shape,

■ generally hyperdense to brain.

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