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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 |