A 65-year-old male is admitted to the hospital three weeks after a "small bump of his head" according to his narrative. He suffered the accidental bump from a low-hanging branch while driving his tractor through the apple orchard during harvesting season. During physical examination the patient displays mental confusion and poor physical coordination. Radiographic examination reveals leakage from a cerebral vein over the right cerebral hemisphere. From what type of bleeding is the patient most likely suffering?
Subdural bleeding usually results from tears in veins that cross the subdural space, between the dura and the arachnoid. This bleeding may cause a gradual increase in intracranial pressure and may result in leakage of venous blood over the right cerebral hemisphere with a variable rate of progression. A subarachnoid bleed is due to rupture of an artery into the subarachnoid space surrounding the brain, between the arachnoid membrane and the pia mater. Hydrocephalus may result if the subarachnoid bleeding or subsequent fibrosis create obstructions to CSF flow through the subarachnoid space or drainage of the CSF. Epidural bleeding results in most cases from tearing of the middle meningeal artery, and this rapidly expanding, space-occupying lesion can cause death within 12 hours. Intracerebral bleeding into the brain parenchyma is focal bleeding from a blood vessel into the brain parenchyma, most likely caused by hypertension and/or atherosclerosis. Typical symptoms include focal neurologic deficits, with abrupt onset of headache, nausea, and impairment of consciousness. Bleeding into the cerebral ventricular system may be due to trauma or hemorrhage of blood from nearby arteries, especially those related to the supply of the choroid plexus.
Subarachnoid bleeding
Epidural bleeding
Intracerebral bleeding into the brain parenchyma
Subdural bleeding
Head & Neck