Acute subdural haematoma

Acute subdural haematomas appear after high speed road traffic accidents, falls, or assaults. They occur experimentally after angular acceleration/deceleration, concentrating injury on vascular elements on the brain surface. They are commonly associated with other parenchymal injuries, which may affect outcome as much as the haematoma itself (Figure 2.1b). Ipsilateral and contralateral skull fractures are common. The haematoma often occurs over the temporal pole, either from tearing of bridging veins or from laceration of the brain and disruption of surface arteries. Arterial bleeding can occasionally produce the clinical picture of lucid interval before deterioration into coma. The common combination of temporal lobe laceration and contusion with an associated subdural haematoma is known as "burst temporal lobe". The typical clinical presentation is one of a focal neurological deficit with or without lowered level of consciousness but with deterioration a few days after injury. Such deterioration is often due to temporal lobe swelling rather than to increase in the size of the haematoma itself.

Figure 2.1 (a) An extradural haematoma is formed when the inner layer of dura is stripped from the skull, tearing the meningeal artery, and results from deformation or fracture of the skull.

Seventy per cent of haematomas occur in the temporal or parietal regions, as this is where the fracture crosses the path of the middle meningeal artery. One in five patients presents with a "lucid interval"; that is, a traumatic brain injury severe enough to cause concussion, followed by improvement in conscious level. Early evacuation leads to good recovery

Figure 2.1 (a) An extradural haematoma is formed when the inner layer of dura is stripped from the skull, tearing the meningeal artery, and results from deformation or fracture of the skull.

Seventy per cent of haematomas occur in the temporal or parietal regions, as this is where the fracture crosses the path of the middle meningeal artery. One in five patients presents with a "lucid interval"; that is, a traumatic brain injury severe enough to cause concussion, followed by improvement in conscious level. Early evacuation leads to good recovery

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