Q&A: Intracranial Haematomas

An intracranial hematoma is a collection of blood within the skull. It's most commonly caused by the rupture of a blood vessel within the brain or from trauma such as a car accident or fall. The blood collection can be within the brain tissue or underneath the skull, pressing on the brain.

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In this article:
Categories of intracranial haematoma
MCQ exam: clinical scenario
MCQ exam: answer
MCQ exam: explanation

Categories of intracranial haematoma

A head injury is the most common cause of bleeding within the skull. A head injury may result from motor vehicle or bicycle accidents, falls, assaults, and sports injuries.

For older adults, even mild head trauma can cause a haematoma. This is especially true if they are on an anticoagulant medication or an anti-platelet drug, such as aspirin.

Serious injuries could occur even if there's no open wound, bruise or other obvious damage.

There are three categories of haematomas — subdural haematoma, epidural haematoma and intracerebral (intraparenchymal) haematoma.

MCQ exam: clinical scenario

Examine the diagram below carefully. Then choose the most correct answer from the choices below:

a) acute extradural haematoma
b) sub-acute acute extradural haematoma
c) acute subarachnoid haematoma
d) subacute subdural haematoma
e) acute subdural haematoma

MCQ exam: answer

The correct answer is D.
This is a right subacute subdural haematoma.

A crescentic shaped abnormality - a feature of hematoma - is seen along the right side of the cerebral parenchyma.

It is isodense by comparing to the related cerebral parenchyma. It exerts mass effect in the form of effacement of the related cortical sulci, compression of the right lateral ventricle with slight mid line shift.

MCQ exam: explanation

Subdural hematomas which become symptomatic between 3 days and 3 weeks after initial injury are considered subacute.

Compared to the normal brain parenchyma, subacute subdural hematomas appear isodense to low density. These collections may be subtle, especially if they are bilateral.

Medial displacement of the gray-white matter interface is an important finding to identify.

Source:
The above question is an MRCP question, but the accompanying brain image is reproduced from an original on Raediopedia. Available online: https://radiopaedia.org/cases/subacute-subdural-haematoma-1