Chronic subdural hematoma in children
Introduction
Introduction to chronic subdural hematoma in children Subdural hematoma (subduralhematoma) refers to the accumulation of blood in the cavity between the arachnoid and dura mater due to trauma or coagulopathy caused by subdural hemorrhage, resulting in craniocerebral injury. According to the morning and evening of clinical symptoms, it is divided into acute, subacute and chronic subdural hematoma. Chronic subdural hematoma refers to symptoms that appear more than 3 weeks after head trauma, and have formed a hematoma of the capsule. The vast majority of hematoma comes from a slight neglected head trauma. Children often suffer from birth trauma. Children with chronic subdural hematoma are mostly bilateral. Hemorrhage originates from the rupture of the bridge vein that merges into the superior sagittal sinus. Low bleeding pressure, slow formation of hematoma, usually does not cause a rapid increase in intracranial pressure. basic knowledge The proportion of illness: 0.002% - 0.0005% Susceptible people: children Mode of infection: non-infectious Complications: optic disc edema, facial paralysis, epilepsy
Cause
Causes of chronic subdural hematoma in children
Cause:
The capsule of chronic subdural hematoma begins to form 7 to 10 days after injury, and is completed after 2 to 3 weeks. The capsule is thicker near the dura mater and the blood supply is rich, and the adhesion is tight; while the arachnoid side wall is close. It is thinner and loosely connected to the surrounding structure. The blood in the capsule has been liquefied. A large amount of denatured hemoglobin and bilirubin make it "soy sauce or brown". The protein content in the liquefied blood in the capsule is high. Infiltration state, can absorb hypotonic cerebrospinal fluid through the inner thin wall, so that the hematoma continues to increase, it is also believed that the permeability of the newly formed vascular wall of the capsule leads to high hemorrhage caused by albumin leakage. Infiltration, recent studies have concluded that the progressive increase in clinical symptoms of children is not entirely due to the compression of hematoma. Large-area hematoma capsules can cause residual drainage and venous drainage of the drainage bridge, further leading to venous return of the cerebral hemisphere. Reduced, eventually these vein embolization will produce venous return cerebral edema, which will aggravate the symptoms of nerve damage.
Prevention
Prevention of chronic subdural hematoma in children
Pay attention to perinatal health care, prevent premature birth, dystocia; improve delivery technology, prevent neonatal brain injury; care for children of all ages to prevent brain trauma; routinely add vitamin K after birth to prevent spontaneous hemorrhagic disease caused by vitamin K deficiency .
Complication
Complications of chronic subdural hematoma in children Complications, optic disc edema, epilepsy
More common optic disc edema or retinal hemorrhage, cortical compression showed signs of focal nerve damage, sputum or pyramidal tract sign positive, central facial paralysis, aphasia or epilepsy.
Symptom
Symptoms of chronic subdural hematoma in children Common symptoms Easy irritating attention Insufficient attention Intracranial pressure increased Locating signs Head enlarged Dizziness Light eyelid changes Before sputum tension increased Retinal hemorrhage
Mainly chronic chronic brain compression and focal neurological localization signs, the child's disease progresses slowly, and the symptoms of chronic intracranial hypertension gradually appear. About 60% of the children show progressive head circumference enlargement, anterior hernia bulging, Vomiting, irritability or lethargy, older children may have headaches, dizziness, inattention, memory loss or vision loss, fundus examination more common optic disc edema or retinal hemorrhage, for head enlargement, vomiting and before Chronic subdural hematoma of swelled swell should be distinguished from congenital hydrocephalus, but the degree of head enlargement of the former is not as good as that of the latter, and the percussion area of the children in hydrocephalus often has drum sounds or broken pot sounds. The percussion in the chronic subdural hematoma area is often blunt, and the separation of the suture is also more pronounced in children with congenital hydrocephalus. About 40% of the children have focal nerves due to cortical compression. Signs of damage, manifested as weakened limb muscle strength, convulsions or pyramidal tract signs positive, central facial paralysis or aphasia and other symptoms; adhesion calcification of the envelope stimulates the cortex to promote epilepsy.
Examine
Examination of chronic subdural hematoma in children
It can be used for diagnostic puncture. The puncture site is selected at 3cm from the medial line of the anterior temporal angle and 0.5cm at 45°. It can reach the subdural space. It can be seen that a large amount of old brown or brown liquid flows out, which can be diagnosed.
The CT scan of the head is mostly characterized by a slightly lower density of the "crescent shape" under the skull. However, the density value is slightly higher than the density of the cerebrospinal fluid because the protein content is increased and the envelope of the hematoma is enhanced. strengthen.
Diagnosis
Diagnosis and diagnosis of chronic subdural hematoma in children
Age less than 6 months, a history of minor trauma or birth injury, after a period of time gradually increased head circumference, chronic symptoms of increased intracranial pressure, accompanied by signs of focal neurological impairment, should be considered Chronic subdural hematoma may be combined with a history of head CT scans. For patients with high suspicion, diagnostic puncture can also be performed. A large number of old brown or brown fluids flow out, and the diagnosis is clear.
Different from diseases that cause chronic increase of intracranial pressure, such as children with congenital hydrocephalus, subdural effusion, children with intracranial space-occupying lesions, can be diagnosed by brain CT and diagnostic puncture and medical history.
