Is bridging vein rupture/thrombosis associated with subdural hematoma at birth?

Acute subdural bleeding is blood collection in subdural space, usually caused by laceration of the bridging vein that runs from cortex to meningeal layer. On the other hand, the acute epidural hematoma is a collection of blood above the dura mater, usually caused by tearing of the middle meningeal artery. Subdural hematoma acute more likely happen in elderly than young adult. This case report discusses acute spontaneous subdural hematoma that was caused by a pseudoaneurysm of the middle meningeal artery. Seventeen years old boy came with symptoms of high intracranial pressure because of massive subdural bleeding. He was undergone craniotomy. After the clot removal operation, Digital Subtraction Angiography revealed vascular blush and pseudoaneurysm of the middle meningeal artery. Onyx embolization was delivered to proximal to a distal branch of the middle meningeal artery. The patient recovered in good condition, and no rebleeding in two years. Conclusion. Acute spontaneous subdural bleeding even though it is quite rare, but the chance of fatal rebleeding is high. As a result, one still has to look for the source of bleeding and manage comprehensively with embolization.

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On the assessment of bridging vein rupture associated acute subdural hematoma through finite element analysis

Computer Methods in Biomechanics & Biomedical Engineering ◽

10.1080/10255842.2016.1255942 ◽

2016 ◽

Vol 20 (5) ◽

pp. 530-539 ◽

Cited By ~ 5

Author(s):

Zhao Ying Cui ◽

Nele Famaey ◽

Bart Depreitere ◽

Jan Ivens ◽

Svein Kleiven ◽

...

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Subdural Hematoma ◽

Acute Subdural Hematoma ◽

Element Analysis ◽

Bridging Vein

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Acute subdural hematoma from bridging vein rupture: a potential mechanism for growth

Journal of Neurosurgery ◽

10.3171/2013.10.jns13272 ◽

2014 ◽

Vol 120 (6) ◽

pp. 1378-1384 ◽

Cited By ~ 23

Author(s):

Jimmy D. Miller ◽

Remi Nader

Keyword(s):

Subdural Hematoma ◽

Cell Layer ◽

Venous Pressure ◽

Feedback Mechanism ◽

Acute Subdural Hematoma ◽

Outflow Resistance ◽

Border Cell ◽

Bridging Veins ◽

Bridging Vein ◽

Cerebral Venous Pressure

Most acute subdural hematomas (ASDHs) develop after rupture of a bridging vein or veins. The anatomy of the bridging vein predisposes to its tearing within the border cell layer of the dura mater. Thus, the subdural hematoma actually forms within the dura. The hematoma grows by continued bleeding into the border cell layer. However, the venous pressure would not be expected to cause a large hematoma. Therefore, some type of mechanism must account for the hematoma's expansion. Cerebral venous pressure (CVP) has been demonstrated in animal models to be slightly higher than intracranial pressure (ICP), and CVP tracks the ICP as pressure variations occur. The elevation of CVP as the ICP increases is thought to result from an increase in outflow resistance of the terminal portion of the bridging veins. This probably results from a Starling resistor model or, less likely, from a muscular sphincter. A hypothesis is derived to explain the mechanism of ASDH enlargement. Tearing of one or more bridging veins causes these vessels to bleed into the dural border cell layer. Subsequent ICP elevation from the ASDH, cerebral swelling, or other cause results in elevation of the CVP by increased outflow resistance in the intact bridging veins. The increased ICP causes further bleeding into the hematoma cavity via the torn bridging veins. Thus, the ASDH enlarges via a positive feedback mechanism. Enlargement of an ASDH would cease as blood within the hematoma cavity coagulates. This would stop the dissection of the dural border cell layer, and pressure within the hematoma cavity would equalize with that in the torn bridging vein or veins.

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Computational Study on the Bridging Vein Rupture of Blast-Induced Traumatic Brain Injury Using a Numerical Human Head Model

Volume 2: Biomedical and Biotechnology Engineering; Nanoengineering for Medicine and Biology ◽

10.1115/imece2011-65733 ◽

2011 ◽

Cited By ~ 1

Author(s):

Chenzhi Wang ◽

Jae Bum Pahk ◽

Carey D. Balaban ◽

Jeffrey S. Vipperman

Keyword(s):

Shock Wave ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Subdural Hematoma ◽

Human Head ◽

Head Model ◽

Cerebral Contusion ◽

Injury Threshold ◽

Bridging Vein ◽

Human Head Model

The occurrence of blast-induced traumatic brain injury (bTBI) in people serving in battle environments is dramatically high. The blast front, or leading edge of the shock wave is a brief, acute overpressure wave that travels supersonically with a magnitude that is several times higher than that of ambient. The shock wave propagates through the human head and injures intracranial tissues. Classical neuropathologic signs of bTBI include cerebral contusion, diffuse axonal injury, subdural hematoma (SDH) and subarachnoid hematoma, of which subdural hematoma is the most dominating sign of bTBI. Here, computational finite element (FE) modeling is used to investigate the mechanical process of bTBI. The overall goal of the present study is to find the injury threshold of the SDH injury due to bTBI, by investigating the biomechanical response of the bridging veins in the human brain under shock wave loading that originates from detonation. This research mainly develops a basic FE human head model which consists of skull and parts of the brain. The geometric models of skull and brain are developed from segmentations of magnetic resonance imaging (MRI) files of a real human head. The boundary conditions on the neck and head are modeled as a displacement-fixed condition. The numerically simulated blast waves are applied on the human head model as external loading conditions. The internal response in the subarachnoid space is used as loadings on the bridging vein submodel. The maximum principal stress of the bridging vein is used to determine the whether there is failure of the bridging vein, thus estimating the “injury threshold” of SDH in bTBI. Results show that 150g TNT blast of 1 meter away from the head can result in a high possibility of SDH occurrence.

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