Extra Dural Haemorrhage
The skull is open. Dura is exposed. On the right parieto-temporal region is a large extra-dural haemorrhage. The origin is ruptured middle meningeal artery, which runs between the dura and and the skull. More often than not it is associated with a fracture. However, 15% occurrs without a fracture.
Clinical Features
The characteristic clinical feature, which has a medico-legal importance, is 'lucid interval'. With the impact the victims may or may not suffer a concussion, which may last for few seconds of minutes. Then they recover from unconsciousness to experience a normal level of consciousness, which is called 'lucid interval'. During that period they could behave normally. For instance they can tell somebody that so and so assaulted them with a club. After some times (average 4 hours) they start to deteriorate and if not surgically intervened, die from complications of raised intra-cranial pressure.
Autopsy Features
The brain of this case should show all the features of raised intra-cranial pressure due to a space occupying lesion namely compression of the right cerebral hemisphere, sub-falcine herniation of the right cingulate gyrus, haemorrhagic necrosis of right uncus, 'Kernohan's notch' on left mid-brain, haemorrhagic necrosis of tonsils and right calcarine sulcus, secondary haemorrhages in the distorted brain stem etc.
Category of Hurt
Since EDH present a very high probability of death unless surgically intervened (promptly) it is considered to be 'fatal in the ordinary course of nature'.
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