Traumatic brain injury

Question 1

Bleeding into the space between the dura mater and the skull. Often results from acceleration-deceleration trauma or a blow to the side of the head. The majority of epidural haematomas occur in the temporal region where skull fractures cause a rupture of the middle meningeal artery.

Features:
- features of raised intracranial pressure
- some patients may exhibit a lucid interval

Answer 1

Extradural (epidural) haematoma

Question 2

Bleeding into the outermost meningeal layer. Most commonly occur around the frontal and parietal lobes.

Risk factors include old age, alcoholism and anticoagulation.

Slower onset of symptoms than a epidural haematoma. There may be fluctuating confusion/consciousness

Answer 2

Subdural haematoma

Question 3

Classically causes a sudden occipital headache. Usually occurs spontaneously in the context of a ruptured cerebral aneurysm but may be seen in association with other injuries when a patient has sustained a traumatic brain injury

Answer 3

Subarachnoid haemorrhage

Question 4

An intracerebral (or intraparenchymal) haemorrhage is a collection of blood within the substance of the brain.

Causes / risk factors include: hypertension, vascular lesion (e.g. aneurysm or arteriovenous malformation), cerebral amyloid angiopathy, trauma, brain tumour or infarct (particularly in stroke patients undergoing thrombolysis).

Patients will present similarly to an ischaemic stroke (which is why it is crucial to obtain a CT in head in all stroke patients prior to thrombolysis) or with a decrease in consciousness.

CT imaging will show a hyperdensity (bright lesion) within the substance of the brain.

Treatment is often conservative under the care of stroke physicians, but large clots in patients with impaired consciousness may warrant surgical evacuation.

Answer 4

Intracerebral haematoma