Which presentation is typical of intracranial hemorrhage following a skull fracture?

• A. Headache with nausea and vomiting and possible seizures within minutes to hours
• B. Gradual onset of dizziness over weeks
• C. Chronic headaches with aura
• D. No neurological deficits ever

Answer: (A)

Acute intracranial hemorrhage after a skull fracture typically presents with a rapid onset of symptoms due to sudden bleeding and a rise in intracranial pressure. Headache with nausea and vomiting, and the possibility of seizures within minutes to hours, fits this pattern because blood is accumulating quickly and the brain is reacting with be rapid neurologic signs. In contrast, dizziness that develops gradually over weeks suggests a slowly expanding process like a chronic subdural hematoma, chronic headaches with aura point to a primary headache disorder, and never having any neurological deficits would be incompatible with an intracranial bleed. So the abrupt onset of headache, vomiting, and potential seizures is the typical presentation after a skull fracture with an acute bleed.