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Subdural
Hematoma Over the Convexity
Subdural
hematomas are due to rupture of the superficial cortical veins that bridge
through the dura mater. Patients with subdural hematomas over the convexity
present with focal seizures, hemiparesis, and gaze preference. These findings
may be followed by the development of a unilateral third cranial nerve
deficit (ptosis and poorly reactive pupil) if herniation occurs. The diagnosis
is established by CT or MRI of the brain. Treatment, if necessary, is
surgical either by subdural taps or direct surgical intervention. Subdural
hematoma should be drained if seizures persist despite administration
of phenobarbital, if the subdural collection is large, or if there is
evidence of midline shift or impending transtentorial herniation.
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Subarachnoid
Hemorrhage
Subarachnoid
hemorrhage may be primary or secondary. Primary subarachnoid hemorrhage
results from bleeding directly into the subarachnoid space due to structural
vascular accidents (rupture of an aneurysm and an arteriovenous malformation),
a coagulopathy, or an unknown cause. More
about... 251
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