Feature
|
Subarachnoid
|
Subdural
|
Extradural
|
Location
|
The inner most layer around the brain tissue
|
Between the dura mater and arachnoid mater
|
The outermost layer, between the skull and dura mater
|
Mechanism
|
Usually due to rupture of a blood vessel (e.g. berry aneurysm or AVM). Pain typically felt at the back of the head
|
Usually due to trauma causing damage to one of the bridging veins. Trauma may be minor and could be many months ago. Can be acute or chronic.
|
Due to direct moderate / severe head trauma. Typically around the eye, causing fracture of the temporal or parietal bone, resulting in laceration of the middle meningeal artery and/or vein
|
Pain
|
Sudden onset, painful
|
|
Likely, and often severe, but not sudden onset
|
Consciousness
|
May become impaired quickly – if so, a very bad prognostic indicator
|
Fluctuates, often over weeks or even months
|
Classically, an initial lucid period, followed by impaired consciousness
|
Neurological signs
|
May be present; are a poor prognostic indicator
|
Often insidious. May involve memory impairment, epilepsy, drowsiness, dizziness. Often occur weeks / months after injury
|
|
Investigations
|
CT – should show irregular shaped bleed. If absent, and still suspicious, do LP to confirm (blood in CSF, CSF turn yellow when left to stand – xanthochromia)
|
CT / MRI – classically shows acrescent of blood around the brain tissue, and midline shift
|
CT / MRI – described as a lens shapedlesion – meaning it is biconvex.
LP is contraindicated!
|
Management
|
If few symptoms, surgical clipping of platinum coiling of aneursm, or if AVM then balloon therapy and stening are beneficial. Give Nimodipine to reduce risk of vasospasm (and ↑ survival) as long as BP can be maintained.
|
Burr hole or craniotomy
|
Surgery to evacuate blood and ligate bleeding vessels
|