SOURCES OF HEMORRHAGE IN DURAL HEMATOMAS - A CONTRIBUTION TO PACHYMENINGEOSIS HAEMORRHAGICA INTERNA

1. The results of studies of four cases of dural hematomas (P.h.i.) indicate that the hemorrhage results from traumatic dehiscence of vessels. The parasagittal, chiefly venular vessels extending from the calvaria to the dura are the source of hemorrhage. 2. From these studies it does not seem justifiable to differentiate between intradural and subdural hematomas. In each the hemorrhage follows trauma. Blunt, mechanical blows to the calvaria produce sheering forces in the falx cerebri, leading to a dehiscence of the laterocaudal intradural vessels or to a rupture of the bridging veins. Clinically the trauma may go unrecognized. 3. The better the parasagittal bridging-vessels are developed, the more readily the pachymeningotic hemorrhage occurs. Consequently, it is associated with adaptive remodeling of the calvaria and is affected by biological changes. The more the layers of the dura tend to separate, the greater the hemorrhage within the dura. The pachymeningosis dissecans is regarded as an aging phenomenon. 4. The extent and course of the bridging-vessels may be determined by histological study of the dura attached to the calvaria. These anatomical factors represent endogenous prerequisites; a third factor is the quality of head trauma. Each of the three contributes in part to the cause of the intradural hemorrhage. The part each factor plays in the development of the intradural hemorrhage varies. © 1968 Springer-Verlag.