Brain Bleed Injuries
Head trauma can cause hemorrhages and hematomas (brain bleeds) in the intracranial space. These brain bleeds are classified as follows: Epidural Hematoma, Subdural Hematoma, Subarachnoid Hemorrhage, Intracerebral Hemorrhage, and Intraventricular Hemorrhage.
An epidural hematoma (EDH) is a collection of blood that occurs between the skull and the dura mater. This type of brain bleed usually is caused by head trauma, and is often associated with a skull fracture. Epidural hematomas produce a pocket of blood that compresses the brain against the rigid skull. A large epidural hematoma can be life threatening and requires emergency surgical intervention to evacuate the blood and alleviate the pressure against the brain before neutral damage occurs.
In March 2009, actress Natasha Richardson slipped and fell during a ski lesson in Canada and suffered what initially appeared to be a mild head injury, with complaints of a headache after her fall. She tragically died hours later because the pressure created by an epidural hematoma continued to build up and compress her brain over time, cutting off the blood supply.
A subdural hematoma occurs in the subdural space between the dura mater and the arachnoid due to the tearing of the small veins connecting the dura mater and the arachnoid. Subdural hematomas are more common than epidural hematomas but similarly can be life threatening and can require surgical evacuation. Depending on the severity of the condition, subdural hematoma brain bleeds carry a mortality rate of 50-90%.
If discovered within three (3) days following an injury, these bleeds are considered an acute subdural hematoma (ASDH). If discovered after three (3) days and up to fourteen (14) days following an injury, it is considered a subacute subdural hematoma (SASDH). A chronic subdural hematoma (CSDH) is a brain bleed that is discovered more than two (2) weeks following an injury.
In April 2009, San Francisco Giants’ pitcher Joe Martinez was hit in the head by a line drive in a game. He suffered a skull fracture and a subdural hematoma.
A subarachnoid hemorrhage (SAH) occurs between arachnoid mater and the pia mater. These hemorrhages usually are caused by ruptures of brain aneurysms (i.e., weak spots in a brain blood vessel), but also can occur due to a head injury. Symptoms include a severe headache, rigidity of neck muscles, nausea, vomiting and an altered level of consciousness.
An intracerebral hemorrhage (ICH) occurs inside the brain tissue. It is mainly caused by trauma, hypertension, rupture of an aneurysm, artery disease, coagulation disorders or brain tumor. Severe intracraniall brain bleeds require emergency surgery.
An intraventricular hemorrhage (IVH) occurs inside the ventricles of the brain. These are mainly caused by the rupture of an aneurysm or head injury. Intraventricular hemorrhages can block the circulation of cerebrospinal fluid and can compress the brain against the rigid skull. It may then be necessary to insert a shunt, which allows cerebrospinal fluid to drain freely into a body cavity. This relieves the pressure and prevents the unnecessary build-up of cerebrospinal fluid that can exert pressure on the brain.