Neuroanatomy Atlas in Clinical Context

64 CHAPTER 4 / MENINGES, CISTERNS, VENTRICLES, AND RELATED HEMORRHAGES

A

B

D

E

C

Hemorrhage in brain

epidural lesions. The patient in E also has small hemorrhages into the substance of the brain in the region of the genu of the internal capsule. Images A – E are CT without contrast. For additional comments on epi dural and subdural hemorrhages, see p. 58. The treatment of choice for epidural hematoma , especially if the patient is symptomatic, or if the patient is asymptomatic but the acute lesion is greater than 1 cm thick at its widest point and has a volume of greater than 30 cm 3 , is surgical removal and hemostasis of bleeders. In subdural hematoma, surgical evacuation is the preferred treatment in symptomatic patients with acute lesions that are 1 cm thick (0.5 cm in pediatric patients) and where there is a midline shift of greater than 5 mm. On the other hand, asymptomatic patients with thin subdural lesions may be followed medically and may not require surgery. Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2024

4-4 Examples of epidural ( extradural ) hemorrhage / hematoma ( A , B ) and of acute ( C , D ) and subacute ( E ) subdural hematoma/ hemorrhage . Note the lenticular shape of the epidural lesions (they do not cross suture lines— A , B ), their loculated appearance , and their loca tion external to the substance of the brain (see also Figure 4-5). In con trast, the acute subdural lesions ( C , D , arrows ) are quite thin and extend over a longer distance on the cortex; they are not constrained by suture lines. Note the midline shift in patients ( A , D ). In E , the subdural hematoma has both chronic and subacute phases. The chronic phase is indicated by the upper two and lower two arrows where the blood is replaced by fluid, and the subacute phase by the mid dle arrow, where fresher blood has entered the lesion. Note the extent of this lesion on the surface of the cortex and its thinness compared with