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Head injury
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
Epidural/extradural haematoma (EDH) is common following head trauma. A collection of blood forms between the inner surface of the skull and outer layer of dura. In 80% of cases EDH is associated with a skull fracture. The bleeding source is usually a torn middle meningeal artery. Occasionally it can result from venous blood from a torn sinus. Commonly patients have a period of lucidity followed by decreasing consciousness, although this is not invariable and cannot be relied upon in diagnosis.
Head
Published in Harold Ellis, Adrian Kendal Dixon, Bari M. Logan, David J. Bowden, Human Sectional Anatomy, 2017
Harold Ellis, Adrian Kendal Dixon, Bari M. Logan, David J. Bowden
The middle meningeal artery (6) is a branch of the maxillary artery, and its accompanying vein, and may be torn, either together or individually, in fractures of the temporal bone. This constitutes the commonest cause of a traumatic extradural haematoma.
Cheryl
Published in Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner, The Integrated Nervous System, 2017
Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner
The outermost layer of the meninges is the dura, a thick, strong sheet of connective tissue. Within the cranial cavity, the dura and the skull bones adhere somewhat to one another, leaving a potential gap, the epidural space (Figure 9.3a). Bleeding from the large artery that supplies the meninges, the middle meningeal artery, occurs between the skull and dura (Figure 9.3b) and is appropriately called an epidural hemorrhage. This is usually caused by trauma to the side of the head in the temporal region of the skull. The dura is composed of two layers, the periosteal and the meningeal.
Middle meningeal artery embolisation for chronic subdural haematomas: the first prospective UK study
Published in British Journal of Neurosurgery, 2022
Saffwan Mohamed, Alvaro Villabona, Oliver Kennion, Rajeev Padmananbhan, Aslam Siddiqui, Shahid Khan, Manjunath Prasad, Nitin Mukerji
The formation of CSDH is thought to be venous in origin, due to rupture of bridging veins traversing the subdural space.4 However, the sustenance and propagation of the collection appear to be more complex. Following the initial haemorrhage, the inflammation cascade and subsequent influx of inflammatory mediators and cells lead to formation of inner and outer membranes in the subdural space. Neovascularisation in the outer membrane layer leads to formation of small, fragile vessels that are susceptible to recurrent rupture and haemorrhage. This contributes to the growth and propagation of the CSDH.5 These vessels are seen as small ‘blushes’ in the terminal branches of the Middle Meningeal artery (MMA) on catheter angiography in patients with CSDH.6 Moreover, studies have shown engorgement of the MMA on MR Angiography in patients with CSDH.7 These observations have led to the utilisation of MMA embolisation as treatment for CSDH. It is hypothesised that cessation of blood flow to the subdural space by MMA embolisation leads to ischaemia and shifts the cascade towards absorption and repair.5
Three-dimensional multimodality fusion imaging as an educational and planning tool for deep-seated meningiomas
Published in British Journal of Neurosurgery, 2018
Mitsuru Sato, Kensuke Tateishi, Hidetoshi Murata, Taichi Kin, Jun Suenaga, Hajime Takase, Tomohiro Yoneyama, Toshiaki Nishii, Ukihide Tateishi, Tetsuya Yamamoto, Nobuhito Saito, Tomio Inoue, Nobutaka Kawahara
A 67-year-old woman presenting with a one-year history of progressive right visual impairment was referred to our hospital. A right anterior clinoidal meningioma 40 mm in diameter was detected by MRI. In 2DI, MR imaging showed encasement by the tumor of the internal carotid artery, middle cerebral artery, and posterior communicating arteries. However, the encased anterior choroidal arteries (AchAs), lenticulostriate arteries (LSAs), and displaced optic nerve were not clearly identified (Figure 2(A,B) in 2DIs. In contrast, fusion of the DRIVE and CE-THRIVE images clearly depicted the optic nerve (Figure 2(C)), and allowed its 3D reconstruction (Figure 2(D)). The feeding arteries were mainly from the recurrent meningeal branch of the ophthalmic artery and the middle meningeal artery, as determined by conventional DSA. Interestingly, 3D-MFI additionally detected one AchA, three LSAs, one elongated anterior temporal artery, and one premammillary artery, which were also encased within the tumor (Figure 2(E,F). In addition, three feeding arteries, the posterior ethmoidal artery, artery of the foramen rotundum, and accessory meningeal artery, were identified (Figure 2(G,H)). Based on these findings, a surgical strategy was developed from a simulation for resecting this tumor as described above (see “3D-MFI validation “); this strategy included strategies needed to preserve perforators, veins, and nerves. The simulation of the surgery was performed, and the actual surgery was performed based on the simulation. During the surgery, we confirmed the arteries and optic nerve represented in the simulation (Figs 2(l–M)), and finally achieved near-total resection without damaging these perforating arteries or the optic nerve.
Spontaneous acute epidural hematoma associated with chronic subdural hematoma due to dural metastasis of gastric carcinoma: a case report and literature review
Published in International Journal of Neuroscience, 2021
Chenhui Zhao, Yi Wei, Jie Liu, Shanshui Xu, Xiaochun Jiang, Guangfu Di
Kim Byoung-Gu [35] reported a case of EDH caused by dural metastasis of primary liver cancer. The origin of hemorrhage was due to the erosive mid-skull base and middle meningeal artery. In a case of spontaneous EDH, Kwang Moo Woo [8] reported that the bleeding was derived from tumor invasive skull base diploic vein, but no obvious neoplasm or dural erosion sign was found during that operation. We describe the first report of dural metastases resulting chronic SDH simultaneous with acute huge EDH leading to brain hernia, which is derived from moderately to poorly differentiated adenocarcinoma in the stomach.