Intracranial Hematoma

Intracranial Pressure Drenage

Fig. 14.26a There is a small left-sided subdural hematoma and severe hemorrhage into the brain parenchyma in the occipito-parietal region in this patient. The hemorrhage shows layering. The additive mass effect of both disease processes increases the intracranial pressure and causes severe mid-line shift, which is probably also the reason for the obstructive hydrocephalus of the right lateral ventricle. The right posterior horn of the lateral ventricle is grossly dilated. The ongoing CSF production further contributes to the intracranial pressure increase. Surgical decompression of the ventricular system is crucial to give the patient a chance of survival. b In another patient, a deceleration trauma has led to a brain contusion temporally on the right (and a fracture, not visible in this window setting) with an associated contre-coup temporally on the left.

rs jÄi this interval, the better the chances of survival. Both the acute and the subacute subdural hematoma may be treated by neurosurgical drainage through one or several burr holes in the skull or openly with craniotomy and evacuation. The chronic subdural hematoma (Fig. 14.25b) may not become symptomatic until weeks after the underlying marginal trauma. If necessary, it is also flushed and drained via a burr hole.

Intracranial hematoma: An intracranial hematoma (Fig. 14.26a) can also occur as a sequel of a severe brain contusion. It may be relieved surgically. In deceleration trauma, "coup" and "contre-coup" lesions may be seen (for the few non-francophiles: punch and counter-punch). These consist of hemorrhages in opposing regions of the brain (Fig. 14.26b). In addition, smaller subarachnoid he morrhages—detectable as fine bright lines or dots within the sulci—can occur as a collateral injury (Fig. 14.27). Subarachnoid hemorrhages (SAH) in the absence of significant trauma are most often caused by rupture of a preexisting aneurysm and resulting hemorrhage (see p. 235, Chapter 11).

Paul's head is spinning, but finally he makes up his mind: there is a classic epidural hematoma along the left superior convexity of the brain. The scalp in this area is swollen as consequence of a direct trauma. The sulci are swollen and the white-matter/gray-matter distinction is decreased, both findings indicating locoregional cerebral edema. Occipitally on the right the sulci are filled with blood. This is a subarachnoid hemorrhage as part of a "contre-coup" phenomenon. The ventricular system is

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