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Hemorrhagic parenchymal contusions and cerebral microhemorrhages are examples of traumatic intra-axial bleeds. [3] Extra-axial hemorrhage, bleeding that occurs within the skull but outside of the brain tissue, falls into three subtypes: epidural hematoma, subdural hematoma, and subarachnoid hemorrhage. [3]
Between them is the epidural space. The two layers of the dura mater separate at several places, with the meningeal layer projecting deeper into the brain parenchyma forming fibrous septa that compartmentalize the brain tissue. At these sites, the epidural space is wide enough to house the epidural venous sinuses. [2] [4] [5]
Extra-axial hemorrhage, bleeding that occurs within the skull but outside of the brain tissue, falls into three subtypes: Epidural hemorrhage (extradural hemorrhage) which occur between the dura mater (the outermost meninx) and the skull, is caused by trauma.
Extra-axial lesions include epidural hematoma, subdural hematoma, subarachnoid hemorrhage, and intraventricular hemorrhage. [38] Epidural hematoma involves bleeding into the area between the skull and the dura mater, the outermost of the three membranes surrounding the brain. [11]
Axial CT scan showing hemorrhage in the posterior fossa [22] Intracerebral bleeds are the second most common cause of stroke, accounting for 10% of hospital admissions for stroke. [23] High blood pressure raises the risks of spontaneous intracerebral hemorrhage by two to six times. [22]
Clinical manifestations of intraparenchymal hemorrhage are determined by the size and location of hemorrhage, but may include the following: [citation needed] Hypertension, fever, or cardiac arrhythmias
The mortality rate is higher than that of epidural hematomas and diffuse brain injuries because the force required to cause subdural hematomas tends to cause other severe injuries as well. [24] Chronic subdural bleeds develop over a period of days to weeks, often after minor head trauma, though a cause is not identifiable in 50% of patients. [11]
Extra attention should be placed on intracranial pressure (ICP) monitoring via an intraventricular catheter and medications to maintain ICP, blood pressure, and coagulation. [2] In more severe cases an external ventricular drain may be required to maintain ICP and evacuate the hemorrhage, and in extreme cases an open craniotomy may be required.