Stephen J. Schueler, M.D.

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Hemorrhage Epidural Anatomy

To better understand epidural hematoma, it helps to understand the anatomy of the brain and meninges.

The dura is the lining that surrounds the brain and the spinal cord. In the head, the dura attaches to specific locations of the inside of the skull. Between the attachment points, blood vessels lie between the dura and the inside of the skull.

Brain Anatomy
The brain is well protected by:

  • The scalp
  • The skull
  • The dura
    • A tough 3-layer sheath that surrounds the brain and spinal cord
    • Layers include the dura mater (strongest layer), arachnoid mater (middle layer), and pia mater (closest to the brain)

The brain is a complicated structure containing many parts. These include:
  • The cerebrum:
    • Made up of two cerebral hemispheres that are connected in the middle
    • It is the largest part of the brain
    • Each area of the cerebrum performs an important function, such as language or movement
    • Higher thought (cognition) comes from the frontal cortex (front portion of the cerebrum)
    • Outside of the cerebrum are blood vessels
    • There are fluid-filled cavities and channels inside the brain
  • The cerebellum:
    • Located in the lower, back part of the skull
    • Controls movement and coordination
  • The brainstem and pituitary gland:
    • Responsible for involuntary functions such as breathing, body temperature, and blood pressure regulation
    • Pituitary gland is the "master gland" that controls other endocrine glands in the body, such as the thyroid and adrenal glands
    • Pineal gland
  • The cranial nerves:
    • Twelve large nerves exit the bottom of the brain to supply function to the senses such as hearing, vision, and taste
  • The cerebral blood vessels:
    • A complicated system that supplies oxygenated blood and nutrients to the brain

The blood supply to the brain is divided into two main parts:
  • Anterior cerebral circulation:
    • The front of the brain is supplied by the paired carotid arteries in the neck.
  • Posterior cerebral circulation:
    • The back portion of the brain is supplied by the paired vertebral arteries in the spine.

Anatomy examples:
  • Carotid artery branches shown on arteriogram
  • Cerebral arteries viewed in cross-section through middle of brain
  • Cerebral arteries viewed from bottom of brain
  • Cerebral arteries on enhanced CT scan
  • Cerebral arteries on arteriogram

Last Updated: Dec 10, 2010 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Hemorrhage Epidural References
  1. Durand P Jr, Adamson GJ. On-the-field management of athletic head injuries. J Am Acad Orthop Surg. 2004 May-Jun;12(3):191-5. [15161172]
  2. Forbes BJ, Cox M, Christian CW. Retinal hemorrhages in patients with epidural hematomas. J AAPOS. 2008 Feb 6; [18258466]Forbes BJ, Cox M, Christian CW.
  3. Hayashi T, Kameyama M, Imaizumi S, Kamii H, Onuma T. Acute epidural hematoma of the posterior fossa--cases of acute clinical deterioration. Am J Emerg Med. 2007 Nov;25(9):989-95. [18022491]
  4. Provenzale J. CT and MR imaging of acute cranial trauma. Emerg Radiol. 2007 Apr;14(1):1-12. Epub 2007 Feb 22. [17318483]
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