Hematoma

1. Epidural Hematoma (Extradural Hematoma)

Location: Between the dura mater (the outermost meningeal layer) and the skull.

Causes:

• Often associated with head trauma, particularly with skull fractures that damage the middle meningeal artery.
• Can also result from arterial bleeds, making it a rapidly expanding hematoma.

Symptoms:

• Loss of consciousness followed by a lucid interval, then rapid deterioration.
• Severe headache, nausea, vomiting.
• Neurological deficits, such as hemiparesis (weakness on one side of the body).
• Dilated pupil on the side of the hematoma due to cranial nerve III compression.

Treatment:

• Emergency surgical evacuation (craniotomy) to relieve pressure.
• Monitoring and supportive care in less severe cases.

2. Subdural Hematoma

Location: Between the dura mater and the arachnoid mater.

Causes:

• Commonly results from tearing of bridging veins due to head trauma.
• More frequent in elderly individuals and those with cerebral atrophy or on anticoagulant therapy.
• Can be acute (following severe trauma), subacute, or chronic (developing over weeks).

Symptoms:

• Acute: Symptoms can be similar to those of epidural hematomas but with a slower onset.
• Chronic: Progressive headache, confusion, lethargy, and neurological deficits like motor weakness.

Treatment:

• Surgical drainage or burr hole craniotomy for acute cases.
• Monitoring and conservative management for smaller, stable hematomas.

3. Subarachnoid Hematoma (Subarachnoid Hemorrhage)

Location: Between the arachnoid mater and the pia mater, within the subarachnoid space where cerebrospinal fluid circulates.

Causes:

• Rupture of cerebral aneurysms or arteriovenous malformations (AVMs).
• Trauma can also cause subarachnoid bleeding.

Symptoms:

• Sudden, severe headache (“thunderclap headache”).
• Neck stiffness, photophobia (sensitivity to light).
• Nausea, vomiting, loss of consciousness.
• Neurological symptoms like focal deficits or seizures.

Treatment:

• Neurosurgical intervention to repair aneurysms or AVMs.
• Management of increased intracranial pressure.
• Supportive care, including blood pressure control and pain management.

4. Intracerebral Hematoma (Intracerebral Hemorrhage)

Location: Within the brain parenchyma itself.

Causes:

• Hypertension, which can cause small vessel rupture.
• Trauma, anticoagulant therapy, bleeding disorders.
• Vascular malformations, tumors, or amyloid angiopathy.

Symptoms:

• Sudden onset of focal neurological deficits, such as hemiparesis, aphasia (language disturbances).
• Headache, vomiting, decreased level of consciousness.
• Seizures may occur.

Treatment:

• Medical management of blood pressure and intracranial pressure.
• Surgical evacuation for large or accessible hematomas.
• Rehabilitation for recovery of neurological functions.

5. Intraventricular Hematoma

Location: Within the ventricular system of the brain.

Causes:

• Often associated with other types of intracranial hemorrhages (e.g., subarachnoid hemorrhage, intracerebral hemorrhage).
• Can result from trauma, aneurysm rupture, or vascular malformations.

Symptoms:

• Similar to other intracranial hemorrhages, with added symptoms of increased intracranial pressure.
• Hydrocephalus (accumulation of cerebrospinal fluid) due to blockage of ventricular pathways.

Treatment:

• Management of increased intracranial pressure.
• Surgical intervention, such as ventriculostomy, to drain blood and relieve pressure.
• Addressing underlying causes.