6.2:
Intracranial hematoma
Headache
frequently occurs in patients with posttraumatic subdural hematomas (Gorelick,
1993). Headaches occur in 11 percent of patients with acute, 53 percent
with subacute, and 81 percent with chronic subdural hematomas, in
McKissocks’s series from 1960 (McKissock, 1960). Because many of the
patients with acute subdurals have alterations of consciousness, headache
may have been underreported. There is wide variation in the headaches from
chronic subdural hematomas and they range from mild to severe and
paroxysmal to constant (Gorelick, 1993). With unilateral headaches, the
patients usually have the subdural hematoma on the same side (McKissock,
1960). A roller coaster headache is a rare cause attributable to a
subdural hematoma (Bo-Abbas and Bolton, 1995; Buruma et al, 1981). That
is, acceleration-deceleration forces of riding on a roller coaster without
direct head trauma--can tear bridging veins leading to a subdural hematoma
and this may be true in severe whiplash injuries without direct head
trauma as well. The headaches associated with carotid dissections may
occur with similar injuries as discussed later. The classic profile of a
patient with an acute epidural hematoma is one who sustains even a minor
head injury with or without initial loss of consciousness followed by a
lucid interval, but then deteriorates into coma, usually within 12 hours
of the injury (Lobato, 1991). There are chronic epidurals, however, which
result in persistent headache often associated with nausea, vomiting, and
memory impairment consistent with a postconcussion syndrome (Evans, 1996).
Eventually focal findings develop and the correct diagnosis may be made.
Sudden
severe headache usually attends the appearance of a significant
intraparenchymal hemorrhage, whether it is due to hypertension, rupture of
vascular anomaly, intraparenchymal hemorrhage from an aneurysm, a large
hemorrhagic infarction, or hemorrhage into a tumor (also see subarachnoid
hemorrhage).
The
syndrome of "occipital apoplexy": sudden headache, stiff neck
and a homonymous field defect is virtually
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