Head Injury

From the last chapter we learnt that acute blood is hyperdense (whiter) compared to the brain. In this chapter we will use that information to identify the various lesions that can occur in the brain following trauma. Although diffuse injury is more common (Figs. 1.10, 1.12 and 1.14), the vast majority of emergency neurosurgical intervention in trauma involves the evacuation of mass lesions like epidural and subdural haematomas as well as intracerebral haematomas; hence we will focus on identifying these lesions promptly. In Fig. 2.1, you should now be able to confidently identify the blood clots. The first thing to recognize is that the blood clot in each case is closely related to the skull. As a matter of fact, it is separating the brain from the skull. You will easily appreciate from further examination of the images that in Fig. 2.1A the clot is biconvex (acute epidural haematoma, EDH) whereas in Fig. 2.1B the clot is crescent shaped like a new moon draped over the surface of the brain (acute subdural haematoma, ASDH).