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Types of hemorrhage

Epidural hemorrhage is bleeding between the skull and outer covering of the brain, the dura matter.  Epidural hemorrhages are frequently caused from a blunt trauma from an assault, fall or other accident.  Approximately 17% of patients with epidural hemorrhage will deteriorate to coma following trauma.


A subdural hematoma is a collection of blood below the inner layer of the dura but external to the brain and arachnoid membrane. This is the most common type of traumatic brain bleeding.  Subdural hematoma may also be spontaneous or caused by a procedure such as a lumbar puncture.  Death rates can be high, even with the best medical and neurosurgical care (Meagher, 2013).  The prognosis depends on the amount of direct brain damage and the damage resulting from the mass effect of the hematoma on the brain (amount of pressure causing the brain to shift or “push” within the skull).  The mortality rate for subdural hematoma is about 60%-80% (Dawodu, 2013).


A subarachnoid hemorrhage is bleeding between the pia and arachnoid membranes covering the brain.  The most common cause is head trauma.  However, some use the term SAH in the setting of non-traumatic hemorrhage, such as those caused by cerebral aneurysm.  Intracranial saccular aneurysms represent the most common cause of nontraumatic SAH.  About 80% of SAH result from ruptured aneurysms and about 6-8% of all hemorrhagic strokes (Becske, 2014). SAH has a very poor prognosis with 10-15% dying before they reach the hospital and 25% die within 24 hours.

Survivors of intracranial hemorrhage are usually left with lifelong recovery and disability.  Stroke is the leading cause of adult disability in the United States.  For traumatic brain injury, the National Institutes of Health Consensus Development Panel estimates that 2.5-6.5 million Americans live with related disabilities.  Risk for intracranial hemorrhage due to hemorrhagic stroke can be reduced by controlling risk factors such as taking blood pressure medication as prescribed by a physician, limiting alcohol use and avoiding illicit drugs. Risk reduction for traumatic brain injury can be reduced by using seat belts, avoiding driving under the influence of drugs and alcohol, wearing helmets and taking measures to prevent falls in the home, hospital or nursing home.

This month we are discussing head trauma and the types of bleeds that can result. The blog topics for this month are:

  • ICH Defined (2/6/15)
  • Causes: Non-Traumatic & Traumatic (2/13/15)
  • Types of Hemorrhages (2/20/15)
  • Legal Implications (2/27/15)

Note: To see all posts in this topic, click here

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