Intracranial Hematoma with Subarachnoid Hemorrhage

Subarachnoid Hemorrhage

Fig. 14.27 a Here you see a small subar-achnoid hemorrhage (SAH, arrow) that was associated with an occipital brain contusion a few centimeters lower. Note the filling of the sulcus with dense blood. b A punch with an iron rod caused this depressed fracture of the skull on the right side. Amazingly, a subtle SAH (arrow) is the only resulting intracranial abnormality.

dilated considerably, which must be due to an obstruction of the CSF drainage. The reason for this remains obscure for Paul, but Gregory comes in time and solves the puzzle: he points out the blood in the right posterior horn of the lateral ventricle, where a small fluid-fluid interface with the CSF is present. Somewhere there must be a paren-chymal bleed that has ruptured into the ventricular system. The tiniest blood clot from this source can obstruct the aqueduct connecting the third and fourth ventricles and thus lead to hydrocephalus requiring surgical ventriculostomy. Patient A is transferred immediately to the neurosurgical OR.

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