Causes and treatment of subdural hematoma
What does the diagnosis of “subdural hematoma”? What measures are being taken in this state and how dangerous is it?
Hematoma is accumulation of blood, resulting in injuries and damage to the blood vessels. There are different types of hematomas, depending on localization. Subdural intracranial refers to the place of its location - the space between the solid and the arachnoid membranes of the brain (the subdural space). Such bruises appear when you break the veins, called bridging, connecting the sinus Dura and the venous system of the brain. Can be widely distributed across the surface of the hemispheres, excluding locations of the processes of the Dura of the brain.
Depending on the speed of formation and development of subdural hematomas are divided into:
- Acute subdural: it manifests itself usually on the first or second day after injury, is very dangerous for patient's health, high risk of death.
- Subacute subdural hematoma: occurs within a few weeks, so it is often confused with a concussion or brain injury, and sometimes with non-traumatic diseases.
- Chronic subdural hematoma: is formed in a period of two - three days to two to three weeks and may not manifest itself even for several years. The prognosis of chronic hematomas are more favorable.
The most common symptoms of hematomas: worsening headaches, accompanied by nausea and vomiting, seizures, bradycardia (abnormal heart rhythm), mydriasis resulting from the hematoma, psychomotor excitation.
When combined with a severe brain injury may experience respiratory distress and movement of blood through the vessels (hemodynamics), a variety of changes in muscle tone, reflexes. In young children it is possible to increase the head in size.
The causes of pathology
- The most common cause of chronic hematoma - injury. Such hematomas are also called traumatic. They typically have acute manifestations. Often occurs on the side opposite to the one where there has been trauma to the head. May also be accompanied by extensive injuries of the cranial vault, sometimes in combination with damage to the bones of the base. Light regular injuries - common causes of chronic hematomas.
- Syndrome baby concussion - a condition that canbe formed as a result of concussion of the child's body (unfixed head tossing) for the reason that babies have subdural space is wider, that is, the bridging veins are stretched and more prone to damage.
- Brain atrophy observed in the elderly or persons suffering from alcoholism. When this occurs, the elongation of the bridging veins, which increases the likelihood of rupture at the injury. In these cases, most often occurs subacute or chronic development of a hematoma.
- In addition to the high risk of development of atrophy in old age increases the probability of formation of a hematoma due to the fragility of blood vessels
- The decline in liquor and, therefore, subarachnoid pressure, which leads to the expansion of a subdural space.
- Some medications (antiplatelet agents, anticoagulants - medicines to reduce blood clotting and prevent blood clots) increases the risk of subdural hematoma.
- The presence of arachnoid cysts located in the arachnoid membrane of the brain.
- Another risk factor for dementia, i.e. dementia, characterized by a persistent decline in cognitive activity loss in varying degrees of previously acquired knowledge and practical skills, and difficulty or impossibility of acquiring new ones.
Subdural hematoma is a very dangerous phenomenon. Education increase in size, resulting in the following complications:
- Compression (compression) of the brain - a life-threatening condition in which there is displacement or impairment of the brain stem.
- The emergence of new formations.
- Damage to the arachnoid lead to getting into the subdural space cerebrospinal fluid - the cerebrospinal fluid contained in particular in the subarachnoid space (between arachnoid and soft meninges).
- Blood clots release chemicals vasoconstrictors that cause constriction of blood vessels and reduction of blood flow in them, which contributes to the deterioration of blood supply to brain cell death and temporary or permanent damage.
Diagnostics pathology and possible treatment methods
Of course, the earlier diagnosed a subdural hematoma, the more favorable the prognosis for the patient. Therefore, when you receive a cranial trauma requires a medical examination to exclude hemorrhage.
The neurologist will examine you, gather medical history and prescribe the hardware tests (CT or MRI). In some cases, CT may fail to identify the chronic form of the disease. After an accurate diagnosisthe doctor prescribes treatment.
Most often subdural hematoma of the brain requires surgical treatment. Sometimes assigned to medical therapy (at impossibility of operation).
In some cases, a hematoma can resolve on their own, but the patient should always be under medical supervision.
Treatment depends on many factors:
- size, localization, speed of expansion of education;
- the age of the patient;
- the presence of other diseases, pathological conditions, injuries.
Removal of hematoma by surgery
Often in the formation of a hematoma (especially acute), surgical intervention is necessary. There are several methods for removing blood clots from a subdural space, including minimally invasive. The preferred method of surgical treatment is determined individually, based on the nature of the process and the health status of the patient:
- Drainage of the hematoma through hrazovoe hole. Appointed in small units, is performed under local anesthesia. In the bones of the skull Burr hole is made through which the catheter. With the help of the outflow of blood from a subdural space and washing the affected cavity (sometimes I make extra hole). After the procedure subduralny drainage leave for a day or two, during which the patient is prescribed bed rest.
- Craniotomy (craniotomy). Conducted the autopsy of the bones of the skull (incising a small area of bone to gain access to the brain) and the Dura of the brain and removal of hematoma, also performed a thorough inspection to identify the source of bleeding and its neutralization (hemostasis). Craniotomy is indicated for acute hematoma with the development of compression and with subacute increased intracranial pressure and constant appearance of new symptoms.
Before the operation the patient passes the necessary tests (blood tests, ECG, chest x-ray) will be taking anti-inflammatory drugs and drugs that prevent blood clotting, eliminated Smoking and alcohol consumption.
8 hours before the procedure do not eat or drink. The whole process is carried out under General anesthesia. Upon completion of the operation the bone flap is fixed back using titanium plates and screws, which are not removed. Muscles and skin are sewn, stitches are removed in 7-10 days. Sometimes 1 - 2 days leave subcutaneous drain.Prescribed in the successful holding of the craniotomy in 2 weeks.
To the recommendations of postoperative recovery include: the elimination of physical activity, a ban on driving and alcohol consumption, the gradual introduction of a walking, special exercises.
Complications after surgery
Patient after surgical removal of hematoma will find a long recovery period (at least 6 months), for which may experience temporary headaches, memory loss, impaired attention. In some cases, a possible manifestation of complications after craniotomy:
- the development of intracranial hypertension - increased intracranial pressure;
- swelling of the brain;
- recurrence or appearance of new lesions;
- the infection;
- convulsions and seizures.
The patient underwent surgery to remove a subdural hematoma, mandatory assigned taking anti-seizure drugs (anticonvulsants). It is necessary for the prevention of seizures that sometimes occur few weeks or months after the procedure, as well as to control already existing accompanying hematoma.
Conservative therapy is indicated for a very small amount of hematoma less than 10 mm) and absence of complications. In addition, treatment of the medicines prescribed, if the patient is in a coma and has stable neurologic status if the patient is too old for the surgery.
Thus, quick detection and removal of hematoma is directly proportional to the positive forecast. Therefore, when you receive injuries it is necessary to undergo a thorough examination, and the elderly and in the presence of brain diseases should always be seen by a doctor.