Case-Based Modules > Case 13 > Stage 3

Sorry! This probably seems totally counterintuitive. The classic teaching has been that epidural hematomas are caused by tearing of the middle meningeal artery, while subdural hematomas are caused by tearing of the bridging veins. The pathophysiology of chronic SDH is complex, and it's now thought to involve a repetitive cycle of bleeding, followed by inflammation and fibrinolytic products, followed by formation of neovascular membranes with friable vessels. It's thought that the neovascular membranes largely derive their blood supply from the middle meningeal artery. Thus, embolizing it would hopefully break this cycle, but it takes time for the blood products that already exist to be resorbed. At least, the lack of continued vascular supply to these membranes would give this resorption process a chance to catch up.

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