The subdural and epidural hematomas are caused by the blood vessels rapturing in the areas of the brain. In most cases, the hemorrhage occurrence is due to the existence of head injuries and the fracturing of the skull, causing significant damage to the vessels within the affected area. Mainly, the epidural occurs as a result of bleeding that Happens from the meningeal artery, while subdural hematoma is as a result of bleeding from Vessels that transport blood away from the brain surface (Matsumoto et al., 2019). In essence, the subdural and epidural hematomas cause accumulation of blood in the brain surface, causing dysfunction of the brain as the brain is submerged and drained, causing various effects on the patient.
Epidural and subdural hemorrhages occur mostly in young people and are caused by severe injuries on the head. Necessarily, epidural hematomas only exist in 2% of head injuries, which indicates that they occur depending on the area of injury and the severity of the damage. Primarily, the epidural cases account for 5% to 15% of these severe injuries that cause death as a result of the shutting down of the brain due to significant loss of blood in the meningeal vessels causing low or no supply of blood and oxygen in the brain. 85% to 95% of these hematomas indicate a fracture of the skull (Zhao et al., 2020), showing that in most cases, the meningeal's rapture is a result of considerable pressure applied from outside the head.
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The occurrence of subdural hematoma is in 5% to 25% of the patients who have suffered a severe head injury. This fact indicates that subdural bleeding is more common than the epidural bleeding among head injury patients. The prevalence of this bleeding is higher among males than females, with a ratio of 2:1 with an annual occurrence of 5 cases in a population of 100000 people (Zhao et al., 2020). Necessarily, the bleeding and its effects are, in most cases long term as they occur throughout life in affected patients causing severe impact on the functioning of the brain and related parts.
The Anatomy of The Brain
The human brain is made three parts, which include the cerebellum, the cerebrum, and the brainstem. The most significant part of the brain is the cerebrum and is divided into the right and left hemispheres. On the other hand, the cerebellum below the cerebrum is much smaller but more significant than the brainstem, which is the relay center that acts as the linkage between the cerebrum and the cerebellum (Sarubbo & Petit, 2020). The brain's right and left hemispheres are connected by the corpus and callosum fibers, which run across the two sides of the brain.
Further, the cerebrum's two sides are divided into lobes that include the parietal lobe, frontal, Broca, temporal, and occipital lobes. Primarily, the cerebrum's surface is referred to as the cortex that appears to be folded and has a total of 16 billion neurons (Sarubbo & Petit, 2020). This number is below that of the cerebellum, which contains a total of 86 billion neurons. These cells in the cortex are called the gray matter, and they appear to have interconnectedness with other white matter, which are axons below the cortex (Sarubbo & Petit, 2020). Significantly, another vital part of the brain is the hypothalamus that is located on the third ventricle and is connected to the pituitary gland by the pituitary stalk. The other part on the brain's surface is the pineal gland located in the same ventricle as the hypothalamus. Additionally, the brain has fluid-filled cavities called ventricles, which contain structures referred to as the choroid plexus. There is an extensive network of blood vessels in the brain.
Physiology
The brain performs various tasks in the body system and lays a key role in controlling all functions of the body, including movement. Essentially, the brain is responsible for actions and reactions to various factors, both internal and external to the system. The two hemispheres of the cerebrum are crucial in the formation and control of functions such as speech and cognition. Mainly, the frontal lobe, which contains the Broca area, controls speech, and is responsible for developing personality, emotions, and motion (Sarubbo & Petit, 2020). On the other hand, the parietal lobe of the cerebrum performs functions such as vision and interpretation of vision and language. Through a functional temporal lobe, the brain ensures the creation n and retrieval of memory through organizing thoughts and hearing. On the other hand, the hypothalamus is in charge of controlling behavior, including involuntary occurrences such as hunger, thirst, and sexual responses (Sarubbo & Petit, 2020). These emotions and behaviors are developed through communication from various parts of the body to the hypothalamus. It necessitates the hypothalamus to trigger reactions to these messages hence causing functions like arousal.
The supply of blood to an [d from the brain is conducted by the carotid artery and the vertebral arteries. These vessels are divided into the right and left arteries, which branch into a network of other vessels, including the middle meningeal artery, which is part of the maxillary artery. Essentially, the critical function of the blood vessels of the brain is to ensure an adequate supply of nutrients, oxygen, and messages through hormones (Sarubbo & Petit, 2020). Essentially, the brain requires enough and consistent supply of oxygen to ensure that the various parts of the brain perform their functions as energy is needed. Messages to regions like the hypothalamus are transmitted through the blood vessels causing different reflexes and functions.
Mechanisms of Pathophysiology
Epidural and subdural hemorrhages affect the brain in various ways by causing damage to specific parts of the brain, consequently leading to failure of the performance of functions. For instance, when an injury occurs, the brain makes abrupt movements that cause it to hit against the skull from inside, causing trauma. In most cases, this trauma leads to the rapture of vessels filling to the area between the cerebrum, which forms a better part of the surface and the skull with blood. The continued accumulation exerts pressure on the brain, causing it to shift. In essence, the brain's swelling damages parts of the cerebrum, such as the frontal lobe, parietal, and the temporal lobes (Zhao et al., 2020). These parts function to ensure retrieval of information, visual interpretation, formation, and motor and speech. Therefore, the damage of the cerebrum areas causes confusion, abnormal vision, drowsiness, and immobility to the patient (Kulesza et al., 2020). Other symptoms include the impairment of speech and vomiting, which are indications of trauma caused by the Brocas in the frontal lobe and the hypothalamus.
Further, the subdural hemorrhage occurs beneath the dura matter due to injury leading to tearing of vessels. The subdural hematoma caused by this leakage may be acute, subacute, or chronic in nature. This tearing of vessels is not necessarily caused by accidents since, in older adults, it occurs as a result of stretching of veins. The leakage of blood fills the space between the brain and skull, causing pressure on the cerebrum on either of the hemispheres. Some of the symptoms of this traumatic brain injury include slurred speech and weakness on either side of the body (Lim et al., 2016). The weakness or paralysis of one side of the body indicates the damage on the right or left corpus callosum. If the pressure is applied on the right side of the cerebrum, specifically on the corpus callosum, the left side of the body suffers the weakness. The epidural and subdural hematomas mainly affect the cerebrum's functioning, causing damage that may cause lasting dysfunctionality and death.
Prevention
Prevention of traumatic brain injuries such as the subdural and epidural hemorrhages includes the mineralization of the occurrence of severe head injuries. Cyclists and workers in sites that have falling objects should wear helmets to reduce the impact on the head during accidents. Protecting the head prevents skull fractures and trauma that cause the rapturing of vessels or movement of the brain (Zhao et al., 2020). Drivers need to put on safety belts when driving to reduce the likelihood of hitting the head on an object in the occurrence of an accident. Mainly, covering the head with the arms is a preventive reflex that ensures the head's protection from injuries during fall. Also, there is a need to avoid performing medical procedures that involve the brain without considering preexisting damages. For example, the physicians should avoid performing epidural anesthesia on patients on anticoagulation, where a bleeding diathesis is apparent (Zhao et al., 2020). The lumbar puncture performance on such patients may further the damage leading to a severe case of epidural hemorrhage.
Treatment
In cases that involve minor subdural hematomas, treatment is not necessary as the hematoma may heal naturally. However, the epidural and subdural hematoma requires surgical procedures such as craniotomy and decompressive craniotomy to remove the skull's hematoma (Gutowski et al., 2018). Aspiration is also used to treat epidural hematoma where a burr hole is drilled and the fluid between the skull and the brain. The use of anticonvulsants is crucial in the management of seizures in severe cases.
There is a need for patients to undergo therapeutic procedures to enhance their ability to move and speed up the recovery process. The therapies help in ensuring that the body parts of the patient function normally. For instance, speech therapy is significant for children who have undergone the surgical treatment of the condition to help improve their speech (Gutowski et al., 2018). Additionally, therapy could be crucial in enhancing the cognitive ability of the patient.
Conclusion
The epidural and subdural hemorrhage causes various short-term and long-term effects on the patient's system. In essence, this condition is caused by the accumulation of blood between the brain surface and the skull due to traumatic injury. These hematomas manifest through symptoms such as dizziness, loss of memory, speech impairment, and confusion, which indicate damage to areas of the cerebrum, such as the frontal and parietal lobes and specifically the Brocas area of the frontal lobe. The hematomas can be treated through surgical procedures that include drilling the skull to drain the blood.
References
Gutowski, P., Meier, U., Rohde, V., Lemcke, J., & von der Brelie, C. (2018). Clinical outcome of epidural hematoma treated surgically in the era of modern resuscitation and trauma care. World Neurosurgery , 118 , e166-e174.
Kulesza, B., Mazurek, M., Rams, Ł., & Nogalski, A. (2020). Acute Epidural and Subdural Hematomas After Head Injury: Clinical Distinguishing Features. INDIAN JOURNAL OF SURGERY .
Lim, G., Zorn, J. M., Dong, Y. J., DeRenzo, J. S., & Waters, J. H. (2016). Subdural hematoma associated with labor epidural analgesia: a case series. Regional Anesthesia & Pain Medicine , 41 (5), 628-631.
Matsumoto, H., Minami, H., Yamaura, I., & Yoshida, Y. (2019). Postoperative subdural hematoma with blood flow from an epidural hematoma through a tear at the suture point of an artificial dura substitute. Acta neurochirurgica , 161 (4), 755-760.
Sarubbo, S., & Petit, L. (2019). Organization of the white matter anatomy in the human brain. Frontiers in Neuroanatomy , 13 .
Zhao, C., Wei, Y., Liu, J., Xu, S., Jiang, X., & Di, G. (2020). Spontaneous acute epidural hematoma associated with chronic subdural hematoma due to dural metastasis of gastric carcinoma: a case report and literature review. International Journal of Neuroscience , 1-6.
