Traumatic Intracranial Hematomas:

Epidural:

• This is a collection of blood outside the dura and underneath the skull. They are most commonly found in the temporal area of the head and are usually associated with fracture and tearing of vessels either arterial (65% of cases) or venous (35% of cases). Epidural hematomas are uncommon in roughly 5% of head injuries but occur in about 9% of patients in a coma. If treated, early prognosis is excellent because there is usually no brain injury. The outcome is related to the status of the patient before undergoing surgery.

Subdural:

• Occurs in approximately 30% of head injuries. Prognosis is much poorer because it is usually associated with brain injury either from a laceration of tissue, or compression of the brain by collected blood. Early evacuation can decrease mortality which occurs about 60% of the time.

Contusions/Intracerebral Hemorrhages:

• These are common in head injury cases and are often seen with subdural hematomas. These hemorrhages can occur at any site but are more common in the frontal and temporal areas and can get the classic “salt & pepper” appearance. Management depends upon the neurological state of the patient but early evacuation in the right situation can be life-saving.