subdural hematoma
Introduction
Introduction to subdural hematoma Subdural hemorrhage refers to hemorrhage between the dura mater and the arachnoid membrane, which is often referred to as a subdural hematoma because of the tendency to accumulate. According to the time of clinical symptoms and signs after injury, it can be divided into acute, subacute and chronic types. The symptoms of intracranial hematoma within 3 days after head injury are called acute subdural hematoma, 3 days to 3 weeks. Those with symptoms of intracranial hematoma are called subacute subdural hematoma, and those with symptoms of intracranial hematoma for more than 3 weeks are called chronic subdural hematoma. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: disturbance of consciousness epilepsy
Cause
Subdural hematoma etiology
Both acute and subacute subdural hematomas are caused by rupture of the cortical blood vessels in the brain contusion.
Most of the causes of chronic subdural hematoma have a history of minor head trauma, especially when the elderly are in front of the anterior or posterior occipital, the brain tissue moves more in the cranial cavity and is most easily torn from the surface of the brain. Intra-sagittal sinus bridge vein, secondary sinus, arachnoid or subdural hemorrhage damaged, non-invasive chronic subdural hematoma is very rare, may be related to aneurysm, vascular malformation or other cerebrovascular disease .
Prevention
Subdural hematoma prevention
Strengthen safety awareness, publicity and education of traffic rules, and prevent accidental trauma; people with epileptic seizures should take medication on time and do not engage in dangerous activities to prevent accidents. If they occur, they should go to the hospital for treatment to prevent blood accumulation. Produces a hematoma.
Complication
Subdural hematoma complications Complications, disturbance of consciousness, epilepsy
1, accompanied by varying degrees of disturbance of consciousness, serious or even death.
2, the complications of surgery are acute epidural hematoma near the operation area, a large amount of gas in the residual cavity and even tension gas cranial, drainage tube into the brain parenchyma and epilepsy.
Symptom
Subdural hematoma symptoms Common symptoms Nausea hypertensive disorder coma coma increased intracranial pressure hematoma formation papilledema cerebral palsy
1, acute subdural hematoma
Because most of the brain contusion and laceration and secondary cerebral edema exist at the same time, the condition is generally more serious, such as heavier brain contusion or hematoma formation, the contusion of brain contusion and cerebral palsy caused by hematoma The coma overlaps, manifesting as progressive deepening of consciousness disorder, no intermediate waking period or improvement of consciousness. The increase of intracranial pressure and other signs of cerebral palsy are more severe in 1 to 3 days. Other acute intracranial hematoma differences, such as brain contusion and laceration is relatively light, hematoma formation rate is slow, it can be consciously improved, its intracranial pressure and cerebral palsy signs can appear after 72 hours of injury, belonging to Asia Acute type, such hematoma and secondary brain edema of brain contusion and laceration are difficult to distinguish from clinical manifestations, a few simple subdural hematoma without brain contusion, the process of disturbance of consciousness and dura mater The external hematoma is similar, with an intermediate awake period, but because it is a bleeding from the bridge vein, the middle awake period can be longer.
2, subacute and chronic subdural hematoma
(1) Symptoms of increased chronic intracranial pressure: such as headache, nausea, vomiting, and papilledema.
(2) Focal symptoms and signs caused by hematoma compression: such as hemiparesis, aphasia and localized epilepsy.
(3) Brain atrophy, symptoms of cerebral insufficiency: such as mental retardation, mental disorders and memory loss.
The disease is easily misdiagnosed as neurosis, senile dementia, hypertensive encephalopathy, cerebrovascular accident or intracranial tumor, etc., middle-aged and elderly people, with or without history of head trauma, if the above clinical manifestations, the disease may be thought of .
Examine
Examination of subdural hematoma
1. Acute subdural hematoma
CT: A high-density, equi-density or mixed-density crescent or half-moon shape between the inner plate of the skull and the surface of the brain can help to confirm the diagnosis. Other CT examinations of the epidural hematoma.
2. Chronic subdural hematoma
CT: If a low-density crescent, half-moon or lenticular image of the skull is found, it can help to confirm the diagnosis. A few can also show high density, equal density or mixed density, and coagulation mechanism in the hematoma cavity. Related to the course of the disease, brain atrophy and thickening and calcification of the capsule were also seen. Other CT examinations of the epidural hematoma were performed.
Diagnosis
Diagnosis and diagnosis of subdural hematoma
It should be differentiated from the following diseases:
1, chronic subdural effusion: also known as dural hydrosalt, most related to trauma, and chronic subdural hematoma is very similar, and even the author diagnosed subdural water tumor is the cause of chronic hematoma, identification mainly by CT or MRI, otherwise it is difficult to distinguish before surgery.
2, cerebral hemisphere occupying lesions: in addition to hematoma, there are brain tumors, brain abscesses and granuloma and other occupying lesions, are easily confused with chronic subdural hematoma, the difference is mainly in the history of no head trauma and more obvious Signs of localized neurological deficits, confirmed by CT, MRI or cerebral angiography.
3, normal intracranial pressure hydrocephalus and brain atrophy: these two lesions are similar to each other and chronic subdural hematoma, have intelligent decline and / or mental disorders, but the above two lesions have no increased intracranial pressure, And imaging examination has a widening of the ventricles, widening of the brain pool and atrophy of the brain parenchyma.
