Senile chronic subdural hematoma
Introduction
Introduction to senile chronic subdural hematoma Subdural hematoma refers to a hematoma with a complete capsule between the dura mater and the arachnoid membrane. The symptoms appear after 3 weeks after injury are called chronic subdural hematoma (CSDH). Because of its atypical performance, it is often confused with brain tumors and cerebrovascular diseases in clinical practice. Therefore, it is important to correctly understand its characteristics. basic knowledge The proportion of illness: 0.0035% Susceptible people: the elderly Mode of infection: non-infectious Complications: stress ulcer phlebitis renal insufficiency
Cause
Causes of senile chronic subdural hematoma
(1) Causes of the disease
The main causes of CSDH in the elderly are craniocerebral trauma, brain atrophy and anticoagulation, antiplatelet drugs and other factors involved in the pathogenesis of the disease, young and middle-aged patients often need moderate to severe trauma can cause the disease, while the elderly due to slow movement, action Inconvenience and other reasons are prone to fall, and mild trauma can cause severe CSDH. The traumatic brain injury mainly damages the bridge vein or cortical venule and hemorrhage. The elderly generally have brain atrophy, which can enlarge the subarachnoid space and the bridge vein is relatively elongated. And filling, increasing the vulnerability of blood vessels, brain atrophy also makes the cranial cavity relatively enlarged, when the head accelerates or decelerates, the bridge vein is easy to tear or break and hemorrhage, the elderly intracranial pressure is relatively low, once a small amount of dura mater Lower hemorrhage is not easy to stop by itself, it is easy to form a hematoma and produce an envelope, and the new capillary endothelium in the capsule secretes excessive tissue plasminogen activator (tPA), which causes local fibrinolysis. Coupled with anticoagulant, anti-platelet drugs, easy to cause re-bleeding of the neovascularization of the capsule, leading to continuous expansion of the hematoma, which is the reason for the obvious CSDH in the elderly with mild head injury.
(two) pathogenesis
The main reason for CSDH in the elderly is that it is easy to fall due to inconvenience. Slight trauma can lead to the disease. In addition, the relative movement of the brain and skull increases, which can easily cause tearing of the bridge vein, even under mild violence, which may result in Simple subdural hematoma.
Prevention
Senile chronic subdural hematoma prevention
Old and frail patients, especially those with limited mobility, need to be accompanied to prevent falls, so as to avoid accidents.
Complication
Senile chronic subdural hematoma complications Complications, stress ulcer, phlebitis, renal insufficiency
Another characteristic of CSDH in elderly patients with cranial trauma is that it is prone to various complications such as pulmonary and hematoma infection, low intracranial pressure, stress ulcer, hematoma recurrence, heart and kidney dysfunction and thrombophlebitis.
Symptom
Symptoms of senile chronic subdural hematoma common symptoms consciousness disorder memory impairment personality change dementia coma low intracranial pressure syndrome
1. History of trauma is mild or unclear. Young and middle-aged CSDH patients often have a clear history of moderate and severe traumatic brain injury. Older patients have only a slight history of head trauma. Some patients have not been noticed or forgotten due to memory impairment. Denying a history of trauma, only about 70% of the history of craniocerebral injury can be provided.
2. Long incubation period After the trauma of the elderly, the symptoms are mostly more than 3 months, some of which are several years, while the young and middle-aged patients have symptoms in several days to several weeks. Due to the slow development of the disease, the incubation period is longer and more increased. Patients and their families have forgotten the history of trauma, so it is important to carefully follow up on the history of injury.
3. Psychiatric symptoms highlight the first and most common symptoms of CSDH in the elderly are psychiatric symptoms, such as dementia, personality changes, memory disorders, orientation, judgment and loss of self-knowledge, etc., because the hematoma only produces cerebral or cortical compression, hemiplegia, etc. The sign of the body is not obvious, and coma and disturbance of consciousness are rare.
4. The amount of bleeding is large due to re-bleeding of the neovascularization of the capsule, etc., the amount of CSDH bleeding in the elderly is larger than that of the young and middle-aged (usually more than 100ml), and the amount of bleeding is often not proportional to the symptoms.
5. The intracranial hypertension is not obvious. Because the cranial cavity is relatively enlarged, the brain tissue compression and intracranial hypertension are not as typical as the young and middle-aged patients.
6. CT shows that the density of the same density is more common. The CT of CSDH shows high density, low density, equal density and mixed density. The elderly patients show more density than the younger and younger. Therefore, attention should be paid to the ventricular system pressure. And the phenomenon of shifting the midline structure, and further MRI or cerebral angiography or intensive CT examination to confirm the diagnosis.
Examine
Examination of senile chronic subdural hematoma
CSDH co-infected, blood, white blood cells can be elevated, severe electrolyte imbalance.
The flat slice of the skull shows that the fracture line can indicate the location of the hematoma, and abnormalities can be seen by CT or MRI.
Diagnosis
Diagnosis and diagnosis of senile chronic subdural hematoma
diagnosis
The diagnosis of elderly CSDH is not difficult in the history of obvious head trauma, focal signs and intracranial hypertension. However, when patients can not provide a history of trauma, in addition to a detailed understanding of their clinical features, they must rely on CT or MRI.
Differential diagnosis
The disease needs to be differentiated from cerebrovascular disease, brain tumor, normal intracranial pressure hydrocephalus and mental illness.
