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Haemorrhage may occur into the extradural, subdural or subarachnoid space, or within the brain substance itself.
In the context of trauma, extradural haematomas are usually temporal or temperoparietal. They are important since they can precipitate quite sudden deterioration in conscious level as a result of brain shift, often in the absence of significant neuronal injury. Sudural haematomas most commonly occur in association with surface contusions and lacerations of a temporal lobe. A traumatic intracerebral bleed is most common in the frontal region and is usually more superficial than that associated with hypertension.
CT or MRI scanning is indicated by the presence of a fracture and the level of consciousness, rather than awaiting evidence of cerebral herniation.
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