A short talk about two of the traumatic intracranial bleeds, namely extra and subdural hematomas. Directed to med students moving from basic into clinical teaching.

1. TRAUMATIC INTRACRANIAL
HEMORRHAGE
Walid S. Maani MD, DS, FRCS
Professor of Neurosurgery
Jordan University Medical School
Amman - Jordan

2. WE SHALL TALK ABOUT TWO TYPES ONLY
• EXTRADURAL HEMATOMA • SUBDURAL HEMATOMA

4. SO WHAT ARE THE DIFFERENCES?
• BETWEEN SKULL AND DURA
• ARTERIAL BLOOD
• FROM MIDDLE MENINGIAL ARTERY
• LOCALIZED
• USUALLY NO BRAIN INJURY
• OCCASIONALLY WITH LUCID INTERVAL
(25%)
• 25% OF CASES HAVE NO FRACTURES.
• BETWEEN DURA AND ARACHNOID
• VENOUS BLOOD
• FROM BRIDGING VEINS
• WIDE SPREAD
• USUALLY SEVERE BRAIN INJURY
• NO LUCID INTERVAL

5. HOW DO THEY LOOK LIKE IN ACTUAL VIEW?

6. EXTRADURAL HEMATOMA
• Follows direct trauma to the head
• Starts with a period of loss of consciousness for few minutes to
few hours.
• The patient then wakes up seemingly normal, may complain of
headache.
• The patient starts to lose consciousness again
• If the hematoma is not evacuated urgently, the patient will die.

7. EXTRADURAL HEMATOMA
• The first loss of consciousness was
due to the concussion of the brain
• Concussion does not leave
structural changes in the brain
• The patients wakes up and enjoys a
“lucid interval”
• Then as Intra cranial pressure (ICP)
rises and herniation occurs, the
patient loses consciousness again

8. EXTRADURAL HEMATOMA

9. EXTRADURAL HEMATOMA

10. EXTRADURAL HEMATOMA

11. EXTRADURAL HEMATOMA

12. EXTRADURAL HEMATOMA

13. EXTRADURAL HEMATOMA

14. EXTRADURAL HEMATOMA

15. SUBDURAL HEMATOMA
• Follows severe trauma to the head
• Patient becomes unconscious
immediately.
• The patient usually has an
associated severe brain injury in
addition to the hematoma
• Evacuation of the hematoma, even if
done urgently, may not save the life
of the patient who will die from his
brain injuries.

16. SUBDURAL HEMATOMA
• The injury is a combination of
• Direct trauma
• Acceleration-deceleration injury
(coup-contrecoup injury)
• Shearing forces leading to diffuse
axonal Injury (DAI)

17. SUBDURAL HEMATOMA
• The direct trauma will cause
contusions.
• The acceleration deceleration will
cause contusions and lacerations in
addition to the subdural hematoma
• The shearing forces will cause
diffuse axonal injury (DAI)
So acute subdural
hematoma means not only
a hematoma
BUT
An associated severe brain
injury

18. SUBDURAL HEMATOMA

19. EXTRADURAL HEMATOMA

20. SUBDURAL HEMATOMA

21. SUBDURAL HEMATOMA

22. TAKE HOME MESSAGES
• Traumatic intracranial hematomas are serious medical problems
• Although extradural hematoma kills quickly it has a better prognosis
because the brain is not affected
• Subdural hematoma evacuation may not alter the outcome of the
patient because what matters here is the brain injury itself
• Certain sports are very dangerous and may cause serious injuries to the
brain like boxing, kickboxing, car racing, football, diving and so on.
• Awareness of the the seriousness of the injury and speedy management
saves lives.