Posterior fossa hematoma
Introduction
Introduction to posterior fossa hematoma The posterior fossa hematoma is rare. Because the posterior fossa has a small volume, the cerebrospinal fluid flows into the subarachnoid space through the fourth ventricle, and there is an important life center medulla. The cerebrospinal fluid circulation is blocked, and the intracranial pressure is suddenly increased. High and cause cerebellar tonsil, cerebellar tonsil or hematoma can directly or indirectly oppress the medulla and cause central respiratory and circulatory failure, so the condition is more urgent and sinister. Early surgery should be performed to clear the hematoma, rescue the cerebral palsy, and save the patient's life. In addition to the acute, subacute and chronic hematoma in the posterior cranial fossa hematoma, there are also epidural hematoma, subdural hematoma, cerebellar hematoma and multiple hematoma in the site. Usually, because of the different sources and speed of bleeding, the degree of brain damage varies, so the clinical manifestations are also different. Acute hematoma refers to those with increased intracranial pressure, cerebellum and/or brainstem compression within 3 days after injury; subacute hematoma presents symptoms 4 to 21 days after injury, and chronic hematoma presents symptoms for more than 22 days. . basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: respiratory infections
Cause
Causes of post-cranial fossa hematoma
(1) Causes of the disease
Post-cranial fossa hematoma is most common in epidural hematoma, often caused by occipital bone fracture injury venous sinus or vein. Clinically, subacute manifestations are more common, subdural hematoma is rare, cerebellar hematoma is rare, more Due to cerebellar hemisphere contusion, often combined with subdural hematoma, poor prognosis, multiple hematoma, with posterior fossa hematoma accompanied by supratentorial, axillary contusive brain contusion, subdural and (or ) There are more hematomas in the brain.
(two) pathogenesis
The posterior fossa hematoma is mainly seen in the occipital dysfunction. It is often caused by occipital bone fracture and venous sinus or vein. The extradural hematoma is more common. The hematoma is mostly located on the fracture side. A few can cross the midline and involve the contralateral side. Developed on the screen to form a straddle-type epidural hematoma. When the cerebellar cortical blood vessels or the cerebellar surface are injected into the transverse sinus, the subdural hematoma can be formed. The onset is rapid and the cerebral palsy is more likely to form.
Subdural hematoma often accompanied by cerebellum, brain stem injury, bleeding mainly from cerebellar cortical blood vessels or venous sinus and its veins tear, mostly unilateral, rapid development of the disease, prognosis is worse than the epidural hematoma, posterior cranial fossa Hematoma can directly or indirectly compress the cerebrospinal fluid circulation pathway to increase the intracranial pressure to form cerebral palsy, or directly compress the brain stem, thereby causing the patient to breathe, circulatory failure, endangering the patient's life, and the hematoma of the posterior cranial fossa is mostly due to the impact of the occipital impact. As a result, in the hedging part of the forehead, bungee and sputum and other parts are prone to hemispheric contusion and subdural hematoma or intracerebral hematoma.
Prevention
Post-cranial fossa hematoma prevention
Head position and position
Increased head 15 is conducive to venous return of the brain, which is helpful for the treatment of cerebral edema. In order to prevent hemorrhoids, it is necessary to insist on regular turning and other methods to constantly change the part of the body that is in contact with the mattress, so as to prevent the skin of the protruding part from being continuously subjected to ischemia.
nutrition
Nutritional disorders will reduce the body's immunity and repair function, making it easy to occur or exacerbate complications. Early use of parenteral camp, such as intravenous input of 20% fat emulsion, 7% amino acid, 20% glucose and insulin, electrolytes, vitamins, etc., to maintain the need, after the recovery of intestinal peristalsis, you can gradually replace the intravenous route with enteral nutrition. The daily nutrients are given through the nasogastric tube or the nasogastric tube. For more than one month of enteral nutrition, gastrostomy may be considered to avoid inflammation and erosion of the nose, throat and esophagus. In addition to the application of milk, egg yolk, sugar and other mixed diets, intestine nutrition can be prepared into 4.18kl / ral (1kcal / m1) well plus a variety of vitamin wrap and micro-fat, commercial preparations, usually with casein, Vegetable oil and maltodextrin are used as a matrix containing various vitamins and trace elements to prepare 4.18kJ/ml. Total calories and protein, about 8400kj (2000kcal) per day for adults and 10g of nitrogen can be supplied. If there is high fever, infection, increased muscle tone or epilepsy, it should be increased as appropriate. Regular measurement of body weight and muscle fullness. Monitor nitrogen balance, plasma biochemical indicators such as protein, blood sugar, electrolytes, and immunological tests such as lymphocyte counts to adjust calories and supply of various nutrients in a timely manner.
Complication
Post-cranial fossa hematoma complications Complications, respiratory infections
In addition to the general complications of craniocerebral injury and craniotomy, the management of the respiratory tract should be noted.
Symptom
Post-cranial fossa hematoma symptoms Common symptoms Coma increased intracranial pressure intracranial hypertension irritability disturbance disorder cerebral palsy muscle tone reduction ataxia scalp hematoma edema
1. More common in the occipital injury: focus on the skin contusion or scalp hematoma, a few hours after the suboccipital or mastoid subcutaneous congestion (Battle sign).
2. Increased acute intracranial pressure: severe headache, jet vomiting, irritability, Cushing reaction, slow breathing, slow pulse, elevated blood pressure, etc. Subacute and chronic, may have optic disc edema.
3. Disorder of consciousness: The post-injury consciousness disorder is longer, the degree can be gradually increased, or the conscious period continues to coma.
4. Focal neurological signs: cerebellar involvement can occur nystagmus, ataxia, reduced muscle tension on the injured side; brain stem involvement can occur cross-caries, pyramidal tract signs, cortical tonic and so on.
5. Neck stiffness: One side of the neck muscles are swollen, forcing the head position, which is characteristic of it.
6. Cerebral Palsy Signs: Vital signs are disordered, respiratory arrest can occur earlier, and the pupils can vary in size from side to side. When the cerebellum is incision, the pupils can be enlarged and the light reflection disappears.
Examine
Examination of posterior fossa hematoma
1. X-ray film: Tang's tablet shows occipital fracture, herringbone separation and so on.
2. CT scan: can show high density hematoma, bone window can show fracture.
3. MRI scan: CT scan can affect the lesion display due to bony artifacts of the posterior cranial fossa. MRI examination is needed, which is consistent with the MRI manifestations of hematoma.
Diagnosis
Diagnosis and differentiation of posterior fossa hematoma
There is a history of traumatic occipital trauma, neck stiffness, forced head position, Battle sign, severe vomiting and other clinical manifestations, that is, there may be a possibility of hematoma in the posterior fossa, due to the lack of specific clinical signs of such hematoma, in addition to progressive In addition to the symptoms of intracranial hypertension, there are no obvious signs of nervous system localization, so early diagnosis has certain difficulties. It can take X-ray frontal anterior (Towne's) flat film, more than 80% can see occipital fracture and/or bone. Separation of the suture, further CT scan to confirm the diagnosis, can show high-density hematoma images, if necessary, MRI examination.
CT scan can identify the location of the hematoma, nature, the fourth ventricle and brain stem compression, supratentorial lesions.
