subdural hematoma in children
Introduction
Introduction to subdural hematoma in children Subdural hematoma (subduralhematoma) refers to the subdural hemorrhage caused by trauma or coagulopathy, and the accumulation of blood in the cavity between the arachnoid and dura mater, which is caused by clinical symptoms. Divided into acute, subacute and chronic subdural hematoma. basic knowledge The proportion of illness: 0.008%, the incidence of head trauma is as high as 0.5%-2% Susceptible people: children Mode of infection: non-infectious Complications: Cerebral palsy
Cause
Causes of subdural hematoma in children
(1) Causes of the disease
Mostly caused by trauma, neonatal caused by birth injury, some children due to coagulation mechanism disorders, such as vitamin K deficiency or spontaneous bleeding caused by hemophilia.
(two) pathogenesis
Acute subdural hematoma refers to the subdural hematoma with clinical symptoms within 3 days after head trauma, and its incidence is significantly lower than that of epidural hematoma. The reason is that the brain tissue of children is good, and the inner plate of the skull is smooth, so the hemisphericity. The subdural hematoma caused by injury is much less than that of adults. In older children, there are often severe brain contusion and laceration, ruptured cerebral cortical arteriovenous hemorrhage, which can directly flow blood into the subdural space to form a hematoma. Compound subdural hematoma, this type of child develops rapidly, often subdural hematoma and intracerebral hematoma coexist, resulting in a sharp increase in intracranial pressure, short-term formation of cerebral palsy, poor prognosis, in infants, acute hard Subdural hematoma is more common in mild head trauma, bleeding from sinus or bridge vein tear, most no obvious brain contusion, called simple subdural hematoma; children are usually less than 2 years old, often Due to head trauma, deformation of the skull and displacement of the brain tissue, the passage of the bridge vein in the subdural space is pulled to cause rupture and bleeding, venous bleeding is slow, and the primary brain damage is relatively light, so the course of disease Show more moderate, the prognosis is good.
Acute subdural hematoma can also occur in neonates, and multiple secondary to delivery brain injury. The injury is caused by the compression force of the birth canal in the labor process and the application of forceps, the fetal head aspirator. The bleeding is mostly from the bridge vein and The tear of the dural sinus, the child can appear as a short asymptomatic period within a few hours after birth, followed by pale, dyspnea, increased anterior temporal tension, and may be accompanied by local neurological signs such as: limb muscle strength Attenuation, dilated pupils or focal seizures. If the amount of bleeding is high, infants may also have hemorrhagic shock. The diagnosis can be confirmed by CT examination. The acute subdural hematoma is mainly composed of well-formed coagulated blood clots. Therefore, pre-dural subdural puncture drainage is rarely considered, often need emergency craniotomy for subdural hematoma removal and bleeding point electrocautery to stop bleeding, infant seat delivery often leads to posterior cranial subdural hematoma, due to the head Excessive stretching causes the tear of the posterior cranial concave bridge vein and the curtain. The occupying effect of the hematoma can produce obstructive hydrocephalus, which is characterized by bulging and tension of the anterior iliac crest. Obstacles may arise when the respiratory and circulatory function, occipital hematoma evacuation and emergency control bleeding surgery is the preferred treatment.
Some acute subdural hematomas are caused by spontaneous vitamin B deficiency or hemophilia caused by spontaneous bleeding in children, and excessive drainage of cerebrospinal fluid after congenital hydrocephalus ventriculo-peritoneal shunt is also a common cause.
Prevention
Prevention of subdural hematoma in children
Pay attention to perinatal work, prevent premature birth, dystocia, improve delivery technology, prevent neonatal brain injury, care for children of all ages, prevent brain trauma, routinely add vitamin K after birth, and prevent spontaneous hemorrhagic disease caused by vitamin K deficiency .
Complication
Pediatric subdural hematoma complications Complications
When the cerebral palsy is caused, when the hematoma compresses the cortex, localized neurological signs may appear, and seizures may occur.
Symptom
Symptoms of subdural hematoma in children Common symptoms Anterior tendon tension increased abnormal pupils coma children crying disturbing convulsions seizures and epileptic seizures
Combined subdural hematoma due to multiple primary brain contusion, clinical symptoms are more serious, and the disease develops rapidly, there are many primary coma after injury, the degree of coma can be deepened, and there is very little intermediate waking period. According to the different parts of the brain contusion and hematoma, various focal neurological signs or seizures may occur. When the hematoma occupying effect causes cerebral palsy, the vital signs and pupil changes often appear, which is manifested as pupils with different diameters. Sexual breathing, etc., children with simple subdural hematoma, mostly without primary dysfunction, only manifested as mental weakness or irritability after trauma, irritability, more with convulsions, frequent vomiting, hematoma compression cortex At the time, localized neurological signs may occur; if the anterior or posterior fornix is not closed, most of the children have increased or increased anterior tendon tension.
Examine
Examination of subdural hematoma in children
There are no special findings in general laboratory tests. The amount of bleeding may be anemia, and the amount of hemoglobin and red blood cell count in peripheral blood is significantly reduced.
The diagnosis of acute subdural hematoma mainly depends on CT examination. The CT scan is characterized by high-density shadow of "crescent shape" or "half-moon shape" under the skull. The lesion range is wider, and the brain tissue is under pressure to see the internal movement of the cortical interface; When combined with brain contusion and laceration, it can be seen that the spotted irregular high-density shadow in the brain parenchyma, the surrounding edema zone is obvious, and when the space-occupying effect occurs, the ventricular pressure and the midline structure are displaced, and the bone window image is only 11%~ 40% of patients with subdural hematoma found a skull fracture.
Diagnosis
Diagnosis and diagnosis of subdural hematoma in children
diagnosis
According to the medical history, clinical manifestations and auxiliary examinations can be diagnosed.
Differential diagnosis
Different from intracranial hemorrhage and other craniocerebral injury, it is mainly diagnosed by brain CT examination.
