Speaker A
Welcome to the video on intracranial bleed. In this part, we will discuss the causes and presentation, specifically with epidural and subdural hematoma. There are four types of intracranial bleed depending on its location. The first one is an epidural hematoma. The blood is between the skull and the dura. The second type is a subdural hematoma. In subdural hematoma, the blood is underneath the dura. The third kind is subarachnoid hemorrhage. The blood is underneath the subarachnoid membrane of the brain. The last type is intracerebral, or also known as parenchymal hemorrhage. The blood is in the parenchyma of the brain. We will first discuss the common presentations of the bleeds and divide it up into two separate videos for the specific presentations. In terms of the common presentations, the patient will be complaining of headaches, nausea, and vomiting, particularly if there is increased intracranial pressure. They might be complaining of focal neurological deficits. For the physical signs, it is dependent upon which area is being affected by the bleeding. There is a range of presentation. The patient can be completely neurologically normal with a normal GCS to being slightly confused, lethargic, or unresponsive. They can also present with seizure activities. We will now discuss the specific presentation of epidural and subdural hematoma. First, epidural hematoma. Epidural hematoma is caused by direct trauma to the area. Specifically, it is caused by trauma to the temporal bone. Trauma to the temporal bone can cause disruption of the middle meningeal artery, shown here in red. Blood from the artery then rapidly accumulates. The rapidly accumulated epidural hematoma then pushes the brain out of the way. Because of that quick accumulation of bleed, epidural hematoma patients can have a very quick decline in terms of their GCS. After the initial impact, they might have a very brief period of normal GCS, then they can decline rapidly into a GCS of 3. Because of the shift in the brain, rapid herniation can occur. Subdural hematoma are bleeding from bridging veins in the dura. When there is rapid acceleration-deceleration of the head, that can shear these veins, causing bleeding. Subdural hematomas can be caused by falls, but no direct head trauma is needed. Since the bleeding is venous, it is low pressure in nature. Therefore, a subdural hematoma can grow slowly. Patients who are on anticoagulants will be more susceptible to developing subdural hematomas. There are various presentations of subdural hematomas. In younger patients, since they do not have a lot of brain atrophy, their presentation is usually acute after trauma. Their presentations will include headache, decreased level of consciousness, and neurological deficits. In patients who have more brain atrophy, there's more time for the blood to accumulate before causing symptoms in them, and therefore they can present as slow chronic personality changes. Depending on where the subdural hemorrhage is, it can also cause focal neurological deficits. They can also present as increasing falls or increased confusion. The presentation of subdural hemorrhage in this age group can be very subtle. In the pediatric population, diagnosis of a subdural hemorrhage should raise our suspicion for potential child abuse. Subdural hemorrhage in this age group will present with headache, vomiting, decreased level of consciousness, or with focal deficits. They can also present with seizures. On examination, the patient might have an enlarged head circumference or bulging fontanels. They may also present with failure to thrive. Again, we need to look for any other signs of child abuse if subdural hematoma is being diagnosed. In summary, we discussed the presentation of epidural hemorrhage and subdural hemorrhage. In the next section, we would discuss subarachnoid hemorrhage and parenchymal bleed. Thank you for watching.
