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Subdural Hematoma and Following Events

Subdural Hematoma and Following Events

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Intradural Herniation and Tear of Bridging Vein

Intradural Herniation and Tear of Bridging Vein

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When there is an impact against the skull, the brain continues in motion resulting in forces that cause an intradural herniation and tearing of the bridging vein.

 

Forces:

  • Arachnoid trabeculae pull on arachnoid (suction on inner dural layer)
  • As brain moves toward side of impact, subarachnoid pressure is decreased. (suction on arachnoid and inner dural layer)
  • Bridging vein is stretched.
  • Tear of bridging vein occurs at inter-dural/subdural layer.

 

After impact:

  • Blood accumulates in intradural and subdural locations
  • Lower forces required to separate “potential space” between dura and arachnoid so hemorrhage expands between dura and arachnoid

 

Progression of subdural hematoma:

  • Hemorrhage continues along “potential” space between dura and subarachnoid
  • Stretches bridging vein (maybe eventually completely tears it).
  • Hemorrhage obliterates subarachnoid space and compresses brain.
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