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Epidural and Subdural Hematomas: Dangerous Blood Clots on the Brain

To understand epidural and subdural head-injured patients who arrived at an
hematomas -- two serious consequences of emergency department in coma, but they
head injuries -- we need to know the can also be seen in conscious patients.
basic anatomy of the brain and its Epidural hematomas usually occur in
coverings. Imagine an evil carpenter with conjunction with skull fractures, and
an electric drill intent on drilling into this is no coincidence, as the ruptured
a person's brain. What layers would the blood vessel often lies beneath the
drill encounter in its passage from the fracture. The presence of an epidural
outside of the head to its hematoma signifies a highly dangerous
destination?The drill would pass through condition. Between 5 and 43% of people
the skin and then the skull (braincase) who have them die. Emergency surgery to
before penetrating a series of three remove the clot is the usual
membranes comprising the meninges. In treatment.When considering subdural
sequence, the three membranes are the hematomas, it is useful to divide them
dura mater (Latin for "tough mother"), into acute and chronic varieties, with
the arachnoid mater (cobwebby mother) and "acute" meaning the hematoma is new, and
the pia mater (tender mother) and then "chronic" meaning it has been present for
finally the brain itself.Epidural and at least three weeks. (The hematoma can
subdural hematomas are alike in that they also pass through a "subacute" phase,
are masses of clotted blood (hematomas) meaning that it has been present for 3
caused by head trauma and deposited days to 3 weeks.) By the time an acute
outside the brain but inside the skull. subdural hematoma has become chronic, it
However, they differ in their locations is a thick liquid instead of a solid
relative to the dura mater. An epidural blood clot, and also appears darker on CT
hematoma lies outside (on top of) the scans.Acute subdural hematomas usually
dura mater, while a subdural hematoma occur in people with obvious and
lies inside (beneath) the dura mater and significant blows to the head. In one
outside the arachnoid mater. Thus, the study they were present in 24% of the
locations of the two kinds of hematoma patients who arrived at an emergency
are encoded in their names -- "epi" is department in coma, but can be present in
Greek for "upon" and "sub" is Latin for non-comatose patients as well. Acute
"below." A third kind of hematoma caused subdural hematomas are associated with a
by head injuries is traumatic death rate between 30 and 90%, with a
intracerebral hemorrhage. These occur figure of 60% typically cited. Emergency
within the brain tissue itself and are no surgery is the usual treatment, though
less serious than those outside the studies have shown that alert patients
brain, but are not the subject of the with small subdural hematomas can do as
current essay.Epidural and subdural well without surgery if monitored closely
hematomas are produced by ruptures of for signs of worsening.Infants are also
different blood vessels. Epidural vulnerable to acute subdural hematomas.
hematomas are usually caused by bleeding Neurosurgeons at the Kaohsiung Medical
from an artery that nourishes the University in Taiwan reviewed records on
meninges known as the middle meningeal 21 children, ages 6 days to 12 months,
artery, while subdural hematomas are who had acute subdural hematomas. In this
usually due to bleeding from veins that case series, "shaken baby syndrome" was
drain blood away from the surface of the the most common cause. Eight of the
brain.Yet another difference between infants underwent an immediate operation,
epidural and subdural hematomas is what and another 11 required delayed surgery.
they look like on computed tomographic While most of the children did well, one
(CT) scans. When the bleeding was recent, baby died and another 7 sustained
both show up as intensely bright objects moderate to severe disabilities from
on the scan, but the shapes of the blood their injuries.Chronic subdural hematomas
clots are different. In epidural often show up in patients over 60 years
hematomas the blood is more limited in of age in whom the head injuries that
its spread because it has to push harder caused them might have seemed trivial
to move outward in the tight space when they occurred, or might even have
between the inner surface of the skull been forgotten. Older people are
and the outer surface of the dura mater. especially vulnerable due to the fact
In contrast, the bleeding that produces that their brains have atrophied (shrunk)
subdural hematomas is more free to spread and the veins draining the surface of the
in the looser space beneath the dura brain are stretched and fragile, easily
mater and typically runs from the front disrupted by glancing blows. Risk of
of the head to the rear.One issue that subdural hematoma rises still higher if
applies to both kinds of hematomas is the individual falls a lot, drinks
that they occupy space -- sometimes a lot alcohol a lot or takes blood-thinning
of it -- within the braincase where there medication.Subdural hematomas can expand
isn't a lot of extra space to go around. progressively to the point of causing
As they expand they compress the brain symptoms like headache, slurred speech,
tissue next to them and additionally confusion, lethargy, unsteadiness or even
raise the pressure within the skull which a seizure. Surgery to remove the hematoma
can damage the rest of the brain. and stop the bleeding is the typical
Moreover, the hematoma is not necessarily treatment, and 93 to 97% of patients
the only problem caused by the head survive to 30 days after surgery. Most
injury. The blow to the head that caused regain their pre-injury level of
the bleed can also damage the brain function. Milder cases of chronic
tissue directly.Who gets epidural subdural hematoma can be monitored
hematomas? They usually occur in people without surgery.(C) 2006 by Gary
with obvious and significant blows to the CordingleyGary Cordingley, MD, PhD, is a
head, as from motor vehicle accidents. In clinical neurologist, teacher and
one study they were present in 10% of researcher who works in Athens, Ohio.




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