Causes symptoms and treatment of epidural hematomas
Epidural hematoma is accumulation of blood or blood clots in the space between the outer leaf of the Dura mater and the inner surface of the skull. Its diameter can reach 7 - 8 cm, and the volume varies from 30 to 250 ml causes such hemorrhage closed head injury due to shock.
This kind of hematoma is approximately 1 - 3% of the total number of head injury and 10% for severe injuries. Besides, men more often than women. They are extremely dangerous to life and health, as defeat to be accompanied by the bark, severe brain injury etc. If you do not spend a timely treatment, the high probability of death.
Epidural hematomas occur when head injuries are, as a rule, medium and heavy forms due to damage of the artery located between the skull and the hard shell of the brain. Their causes are quite varied and directly dependent on the degree of impact, its localization.
Usually they are formed under the action of the traumatic agent is a small area on the fixed head. For example, when struck with a stick, a stone, a hammer, a fall in the street, with the bike of the stairs. In addition, this kind of hematoma can occur because of the impetus of moving traffic, when hitting the door jamb, the corner shelves.
According to the "classical" ideas, its occurrence is associated with fracture of the temporal bone.
Most often when an epidural hematoma affects the middle meningeal artery, and therefore it is formed most often in the temporal and adjacent frontal, parietal and occipital areas, as well as in the middle cranial fossa. When this occurs it is usually from the injury, and not the opposite.
Symptoms of epidural hematoma
The formation of epidural hematomas accompanied by a primary loss of consciousness, headache, weakness, dizziness.
Possible amnesia, entrelace, moderate meningeal symptoms and other signs fit within the clinical picture of traumatic brain injury. Among the signs are: increased intracranial and arterial pressure, hypertension, seizures. The side of the impact most often occurs in the extension of the pupil and drooping of the eyelid and on the opposite side may develop muscle weakness, movement disorders.
Mainly for hematomas of this sort are typical distinct lightperiod, the duration of which is individual. Often a relatively satisfactory condition exists for long, a few tens of minutes, rarely hours, then the headaches are getting worse, starts prolonged vomiting, there is drowsiness, secondary loss of consciousness.
In case of such symptoms, need urgent hospitalization because symptoms of the disease begin to progress rapidly, and if you do not take any measures that may be decerebrate, atonic coma, and death.
There are cases, and it's not uncommon for lucid interval erased. Primary loss of consciousness reaches a state of coma, violated vital functions of the body. A few hours may be a temporary revival of the patient, there are severe pain in the head that can be diagnosed by obvalivanie sick head, touch her, etc. This lucid interval is a temporary, can last from several minutes to days, and is then followed by coma.
It is also possible with a complete lack of light period. This is usually associated with severe injuries that are accompanied by a significant traumatic brain injuries. There is soporose or comatose from the moment of injury until surgical intervention at best or death at worst.
Diagnosis, treatment, its consequences and forecasts
Epidural hematoma is diagnosed usually by computer or magnetic resonance tomography. On the MRI of the brain epidural hematoma is shaped like a biconcave lens. When the diagnosis is set to a time interval from the beginning of the injury, after which he developed symptoms. For an acute hematoma, this period is not more than three days, sub-acute for about two to three weeks and chronic for more than three weeks.
In the presence of epidural hematoma in the vast majority of cases need urgent surgical intervention, as extravascular blood leads to increase in intracranial pressure provokes a shift of brain structures beyond their natural boundaries. Apply endoscopic and transcranial removal of hematoma.
For the operation method of the transcranial doing in the skull bone window (trepanation) in the area of the formed hematoma and removed using an aspirator. Then the surgeons find the source of bleeding and carry out a careful hemostasis, that is, hinder, stop or prevent the flow of blood fromthe lumen of the affected vessel.
During endoscopic surgery, the hematoma is removed through a small Presevo hole in the skull. This method is less traumatic, but has its disadvantages. First, you need special equipment, and secondly, through a small hole can be very difficult and sometimes even impossible to revise the wound to remove all clots, and especially to detect the source of bleeding.
After the operation the patient is assigned antibacterial therapy, restorative medication, and physiological procedures. To prevent post-traumatic seizures, it is necessary to use anticonvulsants. The recovery process in adults, can last up to six months, children also recover faster. Followed by full recovery or partial, when there occur headache, dizziness, etc.
Consequence epidermalnogo hemorrhage may be amnesia, increased anxiety, nervosa, disorders of swallowing, attention, possible problems with speech, perception. Besides, sometimes there are epileptic seizures, they can occur directly after the injury, and after a certain period of time.
Conservative treatment is possible, but in extremely rare cases. Usually, it is spontaneous drainage of hematoma in podporujici space through cracks in the surrounding bones. In this way, it is possible to reduce swelling and to remove the accumulation of blood for about four weeks. But to apply this method only in relation to small-volume hematomas and under the control of computer tomography. Moreover, the patient must comply with bed rest and preferably be under constant medical supervision.
In addition, drugs used. First, those that stop bleeding (hemostatic), and then those that contribute to the resorption of hematoma. Shown diuretic drugs (Diakarb, Lasix), causing a decrease in intracranial pressure. In cases, when necessary, carry out prevention of thromboembolism and correction of the blood pressure.
As for predictions, with timely diagnosis and proper treatment in the bright period the mortality is not more than 5 - 10%. In the case when a lucid interval defaced or missing, the number of deaths increases sharply and is already about 20 - 25%. There are cases when the patient is detected and epidural and subdural hematoma simultaneously, which rapidly increases the mortality rate up to 90%.