delayed traumatic intracerebral hematoma
Introduction
Brief introduction of delayed traumatic intracerebral hematoma Delayed traumatic intracerebral hematoma has been reported in the literature, but it has been discovered more frequently since the application of CT scan, and has attracted people's attention. Since the advent of CT, it has been delayed in traumatic intracerebral hematoma. The concept has been more clear, that is, after the head trauma, the first CT examination did not find intracerebral hematoma, after a period of time to check again, hemorrhage began to appear in the brain; or after clearing the intracranial hematoma for a period of time, hematoma was found in different parts of the brain. By. The clinical features of this disease can be summarized as middle-aged and elderly patients, moderate to severe craniocerebral injury caused by decelerating violence. Symptoms and signs gradually worsen within 3 to 6 days after injury, or localized epilepsy, progressive deterioration of consciousness, especially Cases with hypotension, extra-cranial drainage, hyperventilation or strong dehydration should be reviewed in time. basic knowledge The proportion of illness: 0.001% - 0.007% Susceptible people: no specific people Mode of infection: non-infectious Complications: upper gastrointestinal bleeding, malnutrition
Cause
Delayed traumatic brain hematoma
Cause:
The disease is a hematoma formed in different parts of the brain after trauma or after clearing the intracranial hematoma for a period of time.
Pathogenesis
It is currently believed that the formation of delayed hematoma after trauma is related to the following factors:
1. Local carbon dioxide accumulation in brain damage, causing local cerebral vasodilation, further producing perivascular hemorrhage.
2. Vasospasm causes cerebral ischemia, brain tissue necrosis, and multiple rupture of blood vessels.
3. The brain damage zone releases the metabolites of the enzyme, which damages the blood vessel wall of the brain and causes bleeding.
4. Some people think that it is related to diffuse intravascular coagulation and fibrinolysis after trauma.
In addition, controlled hyperventilation during treatment, excessive dehydration caused by intracranial pressure is too low, can aggravate bleeding.
Prevention
Delayed traumatic intracerebral hematoma prevention
The disease is caused directly by the trauma to the head, such as a fall accident. Therefore, pay attention to living habits, high-risk workers, such as construction workers, mining workers are prone to damage, should pay attention to protect themselves in the course of work. Pay attention to calmness and avoid emotional conflicts leading to the disease. Secondly, early detection, early diagnosis and early treatment are also important for the prevention of this disease.
Complication
Delayed traumatic intracerebral hematoma complications Complications upper gastrointestinal bleeding malnutrition
1. Secondary brain swelling and cerebral edema.
2. Severe patients are prone to upper gastrointestinal bleeding, and appropriate measures should be taken to prevent them.
3. Long-term coma patients are prone to pulmonary infection, water and electrolyte balance disorder, hypothalamic dysfunction, malnutrition, hemorrhoids, etc., while strengthening nursing measures, should be dealt with in a timely manner.
Symptom
Delayed traumatic intracerebral hematoma symptoms Common symptoms Cerebral hemorrhage Brain stem hemorrhage disturbance
Most patients with delayed traumatic intracerebral hematoma have no primary injury. After a period of improvement or stabilization, the patient gradually or suddenly develops disturbance of consciousness after several days or weeks, and has a focal neurological sign or original. Symptoms and signs are aggravated. In some patients, the primary injury can be very heavy. The post-injury consciousness disorder can not be improved or aggravated. The CT examination confirmed the delayed intracerebral hematoma.
Examine
Examination of delayed traumatic intracerebral hematoma
1. Brain CT is characterized by a mixed density of hematoma, old hemorrhage in the hematoma and bleeding at different times and at different times, and is characterized by dilated occupying lesions. Can also be expressed as a circular or irregular shape of a high-density mass, CT value of 50 ~ 90Hu, surrounded by low-density edema, accompanied by ventricular morphological changes, midline structure shift and other space-occupying effects.
2. MRI: It is not used for the examination of acute intracerebral hematoma. More performance is T1 and other signals, T2 is low signal, and it is easier to display lesions with T2 low signal.
Diagnosis
Diagnosis and diagnosis of delayed traumatic intracerebral hematoma
Diagnostic criteria
The diagnosis of delayed intracerebral hematoma mainly relies on repeated CT scans, and its medical history diagnosis should meet the following four points:
1. No cerebrovascular disease.
2. Have a clear history of head trauma.
3. The first CT scan after injury showed no intracerebral hematoma.
4. A stroke episode occurs after a period of improvement or stabilization.
Differential diagnosis
In differential diagnosis, this type of "late stroke" is different from hypertensive cerebral hemorrhage. It can be distinguished in terms of age, hematoma distribution and medical history. For cerebral vascular malformations, intracranial aneurysms and intratumoral hemorrhage, there is a history of trauma. In the case, it is difficult to distinguish before surgery, cerebral angiography, CT examination and the characteristics of the course of the disease help to differentiate the diagnosis.
