Brain Injury Law Blog : Head Injury : Coma : Personal Injury : Las Vegas Nevada Lawyer & Attorney Tim Titolo

 Subdural Hematoma and Epidural Hematoma

We all have heard the terms subdural hematoma and epidural hematoma.  Whether we or someone we knew was injured in sports, or involved in a traumatic event, we’ve heard it.  But what does it all mean?

A subdural hematoma occurs when blood vessels between the brain and its outermost membrane rupture.  This causes blood to leak into that area which then causes compression of the brain tissue.  This will potentially damage the compressed tissue.  Chronic subdural hematoma may follow an episode of “mild” traumatic brain injury.  But please keep in mind that any injury to the brain, even if categorized as “mild” or “minor” can have devastating consequences for its victim.

An epidural hematoma, commonly referred to as an extradural hemorrhage, occurs when there is a rupture of a blood vessel, usually an artery, which then bleeds into the space between the "dura mater" and the skull. The affected vessels are often torn by skull fractures.  This is most often the result of a severe head injury, such as those caused by motorcycle or automobile accidents.

It is easiest to distinguish the two types of hematoma visually.  Note the epidural hematoma is blood between the skull and the outside of the membrane covering the brain (dura). A subdural hematoma is between the inside of the dura and the brain itself.

              The blood puts pressure on the space that the brain occupied causing the brain to be displaced.  If significant, the brain can be injured by the pressure.  That is why, many times, a portion of the skull is removed to allow extra room the brain to expand.  A craniotomy or craniectomy is such a procedure.  The procedure is very risky.

               I had a case where an 18 years olds brain began to swell after a bicycle injury.  The doctor saved him by removing part of his skull and storing it for a month while the brain swelling diminished.  The boy wore a helmet to protect his exposed brain and attended cognitive therapy for the month his skull was open.  All looked wonderful for my client since he made great strides in therapy.  He looked forward to being ready for the new college semester and playing guitar in his band.  Unfortunately, during the placement of his skull flap over the exposed brain, he developed a seizure and other complications.  As a result, he developed memory and cognitive impairments and a clawed right hand. Today he is not able to attend college or play his guitar.

               Well now you should be able to distinguish an epidural hematoma from a subdural hematoma.   You can always read more about traumatic brain injury by visiting my Brain and Spine Injury Law Blog or Titolo Law Office website.

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Unlike most forms of traumatic death, a large percentage of the people killed by brain trauma do not die right away but rather days to weeks after the event. In addition, rather than improving after being hospitalized, some 40% of TBI patients deteriorate. Primary injury (the damage that occurs at the moment of trauma when tissues and blood vessels are stretched, compressed, and torn) is not adequate to explain this degeneration. Rather, the deterioration is caused by secondary injury, a complex set of biochemical cascades that occur in the minutes to days following the trauma and contribute a large amount to morbidity and mortality from TBI.

Secondary injury events are poorly understood but are thought to include brain swelling, alterations in cerebral blood flow, a decrease in the tissues' pH, free radical overload, and excitotoxicity. These secondary processes damage neurons that were not directly harmed by the primary injury.
 

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