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Subdural hemorrhage can be broken down.

Sub means below, "dural" which refers to the outermost protective layer of the brain,

which is called dura mater, and "hemorrhage" refers to bleeding.

So, a subdural hemorrhage is when there's bleeding below the dura mater.

OK - let's start with some basic brain anatomy.

The brain is protected by 3 thin layers of tissue called the meninges which covers the

brain and spinal cord.

The inner layer of the meninges is the pia mater, the middle layer is the arachnoid mater,

and the outer layer is the dura mater.

The pia and arachnoid maters, are also called leptomeninges.

Between the leptomeninges, there's the subarachnoid space, which houses cerebrospinal fluid, or

CSF.

CSF is a clear, watery liquid which is pumped around the spinal cord and brain, cushioning

them from impact and bathing them in nutrients.

The outer membrane, the dura mater consists of two layers.

The internal layer of the dura mater lies above the arachnoid mater - the two are separated

by the subdural space.

The external layer of the dura mater adheres to the inner surface of the skull.

These two layers of the dura mater travel together, but at certain spots, the internal

layer of the dura mater separates from the external one to form the meningeal folds.

The meningeal folds help divide the sections of the brain like the falx cerebri which separates

the two hemispheres of the cerebrum, and the tentorium, which covers the cerebellum and

separates it from the cerebrum.

The subdural space plays a major role in venous

blood drainage in the brain.

The surface of the brain is supplied by numerous arteries in the subarachnoid space that provides

oxygen rich blood to the brain.

After the brain tissue has taken up the oxygen and nutrients, the blood drains into superficial

cerebral veins, or bridging veins, that also sit in the subarachnoid space.

These veins travel through the arachnoid mater, pass through the subdural space and penetrate

the inner layer of the dura mater to drain into the dural venous sinuses located between

the two layers of the dura mater.

Eventually the blood in the venous sinuses drain into the internal jugular vein and returns

to the heart.

So, the main cause of a subdural hemorrhage is a rupture of the bridging veins located

in the subdural space.

When a blood vessel is damaged and there's active bleeding, it's called a hemorrhage,

and the collection of blood that results is called a hematoma.

Some people, like the elderly often have brain atrophy where their brain shrinks in size,

and that means that the bridging veins are stretched across a wider space where they

are largely unsupported - a bit like a long rickety bridge across a mountain pass.

In infants and in individuals that abuse alcohol the veins are thin walled, and therefore more

likely to break.

Subdural hematomas are common in head traumas like falling in a wet bathtub and whacking

your head or in shaken baby syndrome where a baby is violently shaken, making their head

whip back and forth damaging the bridging veins.

Subdural hematomas can also occur after an acceleration-deceleration injury like speeding

on the road and then suddenly slamming the brakes.

When that happens, the seatbelt will stop the body and head from moving forwards but

the momentum will carry the brain forward where it impacts the front of the skull.

Right after that, the head moves backwards and hits the headrest causing the brain to

impact the back of the skull.

That rapid back and forth movement once again causes damage to the bridging veins.

Regardless of the mechanism, once a bridging vein is torn, the blood pools in the subdural

space creating a hematoma.

Since the damaged bridging veins are under low pressure, the bleeding can be slow causing

delayed onset of symptoms which might develop over the course of days to weeks as the hematoma

gradually expands.

So an acute subdural hematomas causes symptoms within 2 days, a subacute subdural hematoma

causes symptoms between 3 and 14 days, and a chronic subdural hematomas causes symptoms

after 15 days.

The hematoma can compress the brain and cause increased intracranial pressure.

A large subdural hematoma on one side of the skull can cause a midline shift which is a

displacement of the whole brain towards the opposite side of the skull.

The increased intracranial pressure can also cause the brain to herniate.

There can be a supratentorial herniation where the cerebrum is pushed against the skull or

the tentorium, and an infratentorial herniation where the cerebellum is pushed against the

brainstem.

Both of these can be lethal.

Supratentorial herniations can compress the arteries that nourish the brain leading to

an ischemic stroke and infratentorial herniations can compress the vital area in the brainstem

that control consciousness, respiration, and heart rate.

The most common symptoms of a subdural hemorrhage are loss of consciousness right after the

injury or in the ensuing days to weeks as the hematoma increases in size.

Other symptoms include headaches and vomiting.

Sometimes there can be focal neurological symptoms like muscle weakness or sensory problems

based on the location of the hematoma.

Diagnosis of a subdural hemorrhage is typically done with an imaging study.

On a CT scan, an acute subdural hematoma shows up as a hyperdense mass meaning that it looks

"more white" than the surrounding healthy brain tissue, whereas a chronic subdural hematoma

shows up as a hypodense masses which is "less white" than the surrounding brain tissue.

An "acute on chronic" bleeding is a combination of hyperdense and hypodense, which is seen

in individuals who have a rebleed in the bridging veins after a chronic hematoma has already

formed.

The blood in a subdural hemorrhage is between the inner and outer layers of the dura mater.

So on a CT scan, subdural hematomas follow the contour of the brain and form a crescent-shape

and cross suture lines.

In contrast, epidural hemorrhages cause blood to build up between the outer layer of the

dura mater and the skull.

Since the outer layer of the dura mater adheres tightly to the skull at sutures, epidural

hematomas don't cross suture lines and they push on the brain forming a biconvex shape.

Small subdural hematomas are drained by placing a small tube called catheter, through a drilled

hole in the skull.

Large subdural hematomas require a craniotomy, which is when part of the skull bone is removed

in order to remove accumulated blood below.

Alright, as a quick recap.

A subdural hemorrhage is a bleeding below the dura mater, caused by the rupture of the

bridging veins found within the subdural space.

Subdural hemorrhages are common in trauma, and in some groups, like the elderly, babies,

and individuals that abuse alcohol.

On a CT scan, an acute subdural hemorrhage forms a hyperdense blood collection, whereas

a chronic subdural hemorrhage forms a hypodense blood collection.

Subdural hematomas cross suture lines and follow the contour of the brain forming a

crescent-shape, unlike epidural hematomas which don't cross suture lines and push

on the brain forming a biconvex shape.

For more infomation >> Subdural Hemorrhage - causes, symptoms, diagnosis, treatment, pathology - Duration: 8:56.

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Back Pain Treatment After a Car Accident | Accident Clinic in NE Portland - Duration: 2:23.

- Hey guys, this is Dr. Carl Baird at Evolve Performance Healthcare.

Today we're gonna talk about what you need to do to recover from an injury sustained

in a car accident here in Portland, Oregon.

The first thing to do, is to open a PIP claim.

So what PIP stands for it's Personal Injury Protection.

It's part of your auto insurance policy and it covers you for up to 100% of medical expenses

after a car accident and so a couple things to keep in mind with this is one, again, it's

through your auto insurance policy, so this isn't health insurance and two, even if you

weren't at fault in the accident you open it up through your own auto insurance policy

and then they'll seek reimbursement from the at fault party.

So, it doesn't raise your rates, they get reimbursed 100% but just keep in mind you

have to open it through your own auto insurance policy.

Now, the second thing to do is to schedule an appointment with a medical provider whether

that be an MD, a chiropractor, or a PT.

This is important for two reasons.

The first being that studies have shown that people who receive care early on after a car

accident experience greater long-term results in terms of pain and disfunction after a car

accident.

So, it's really important to get in there early as you all know a lot of times in a

car accident the pain doesn't come on right away.

It's the two to three days later and the second reason we wanna get in early is again, it

has to do with the insurance which as a healthcare provider we are advocate to get the necessary

care and the longer we have in between when the car accident happened and that initial

intake, the harder it is for us to advocate that these injuries were sustained in the

car accident and not caused by something else which is again what the insurance company

wants to prove.

So again, it's really important to get in early and the third is to receive care.

So again, there's a lot of different types of care that help the body heal.

Here at Evolve Performance Healthcare, what we focus on is full body chiropractic care,

manual therapy and rehabilitation with the goal of again, reducing pain quickly and effectively,

two, restoring range of motion, and more importantly, is building that strength and stability to

prevent long-term complications from a car accident.

So there you have it.

Those are the three things you need to do if you're involved in a car accident here

in Oregon and we're happy to help if you go ahead and follow the link down below, or give

us a call, 503-954-2495.

Thanks for watchin'.

For more infomation >> Back Pain Treatment After a Car Accident | Accident Clinic in NE Portland - Duration: 2:23.

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Microneedling: The Easy Treatment Celebs Love That Takes 10-15 Years Off Your Face - Duration: 4:38.

How DO celebrities look half their age without undergoing facelifts? One of their latest favorite procedures is a treatment they can do in their dermatologist's office in just 25 minutes– microneedling

   Do you want to retain your youthful looks as long as you possibly can, just like loads of celebrities do? Then, a new option available in dermatologist offices can help prevent cheek jowls and sagging skin under your chin and on your neck

The new procedure is called microneedling and it involves puncturing your skin with tiny needles that use a radio frequency to inject an electric current into the skin

The combo is a "double whammy," enthuses Dr. Bruce Katz, an NYC dermatologist and Medical Director of Manhattan's JUVA Skin and Laser Center

   "The needles create tiny holes in the skin, which stimulate collagen production and tighten the skin

Then the electric current entering the skin also stimulates the creation of more collagen

It's microneedling on steroids," says Dr. Katz. "The reason that you start to get jowls and sagging skin under the chin and on the neck as you age, is because collagen in your face deteriorates, as you grow older," he adds

Stimulating the creation of new and more collagen tightens the skin again and also fills in fine lines and acne scars

 Also, he points out that exposure to the sun causes collagen to deteriorate, so too much time sun bathing can also cause your cheeks and neck to sag prematurely

To fight back against this with microneedling, patients are first treated with numbing cream to take the edge off the intensity of the treatment, which takes about 25 minutes

The technician will microneedle all across your cheeks, upper lip, jawline and under your chin and down your neck

Some patients also have their décolletage and between their breasts treated to get rid of lines caused by sun exposure

 I tried the treatment and it's a little uncomfortable. I recommend taking two tylenols beforehand to take the edge off the sensation

Four to five treatments at a cost of about $675 for the face or $975 for the face and neck, every two weeks, should get you highly noticeable results, says Dr

Katz. However, you probably won't see the full results for six months, since it takes that long for all the new stimulated collagen to fill in and tighten the loose skin

 I have seen a definite improvement in my own face and neck. Now, yes, microneedling is not cheap, but it's far less than a facelift at $25 to $30,000 plus at least two weeks of downtime after surgery

Microneedling takes less than one hour between numbing and needling and the redness following treatment can easily be covered afterwards and the next day, with makeup

 Take a look at the embedded before and after photos and you can see the great results — it's like a non-surgical facelift

   It's easy to see how celebrities with these treatments plus a little Botox and line and crease filters can maintain looking forever ageless

Now, you can too.