Haemorrhage into the extradural or subdural space will act as a space-occupying lesion and contribute to raised intracranial pressure. The extradural haemorrhage, being under high pressure, can rapidly cause coma and death. The patient may 'talk and die', regaining consciousness after the head injury, only to lapse a few hours later into severe coma. Without acute neurosurgical intervention to drain the blood these patients will die.
Subdural haematomas tend to run a subacute course and as such are of more interest to the psychiatrist. They may present with a failure to improve, or fluctuating drowsiness, weeks or months after the head injury. They may regress spontaneously or may require surgical drainage, but they do have a propensity to recur.
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