Acute subdural hematoma

Introduction to acute subdural hematoma Subdural hematoma is a common secondary damage to craniocerebral injury, which occurs in the frontal area. Due to the different sources of bleeding, it is divided into a composite subdural hematoma and a simple subdural hematoma. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: swelling, brain edema, upper gastrointestinal bleeding, coma, malnutrition, hemorrhoids

Cause of acute subdural hematoma

(1) Causes of the disease

Acute subdural hematoma is caused by rupture of cortical blood vessels caused by brain contusion and laceration. It is a complex subdural hematoma. The source of acute subdural hematoma is mostly cortical arteriovenous rupture of brain contusion and laceration, mostly complex subdural. Hematoma, that is, hematoma in the same part, cerebral contusion coexist, and some epidural hematoma coexist; some acute subdural hematoma hemorrhage originated from bridge vein injury, primary injury is mild, such hematoma is not accompanied by brain contusion Injury or brain contusion is mild, called simple hematoma.

(two) pathogenesis

The hemispherical contusion and laceration caused by decelerating injury, the hematoma is often on the opposite side of the injury, which is the most common in clinical practice; the brain contusion caused by accelerated injury, the hematoma is mostly on the same side, and the occipital part is on one side. Due to the relative movement of the brain in the cranial cavity, the anterior and posterior cranial fossa can cause a combined subdural hematoma of the contralateral frontal and temporal cerebral contusion and vascular tear; the midline of the occipital region is easy to cause bilateral frontal lobe Hemorrhoids in the blemishes; when the lateral side of the head is stressed, the ipsilateral side is mostly a combined subdural hematoma or epidural hematoma, the contralateral side can cause a complex or simple subdural hematoma, the forehead injury, young people Injury and violence can form a complex hematoma. Simple subdural hematoma is rare. Because the occipital lobe is close to the smooth cerebellum, there is very little hemorrhagic injury and subdural hematoma in the heel area. The elderly have a certain degree of brain atrophy. And the vascular fragility is increased, and the forehead is more likely to have a subdural hematoma.

Acute subdural 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.

Acute subdural hematoma complications Complications swelling cerebral edema upper gastrointestinal bleeding coma malnutrition acne

In addition to the general complications of craniocerebral injury and craniotomy, the following four conditions should be noted.

1. Postoperative observation should be closely observed, and recurrent hematoma and delayed hematoma should be treated promptly.

2. Secondary brain swelling and cerebral edema should be properly controlled.

3. Severe patients are prone to upper gastrointestinal bleeding, and appropriate measures should be taken to prevent them in the early postoperative period.

4. Long-term coma patients are prone to pulmonary infection, hypothalamic dysfunction, malnutrition, hemorrhoids, etc., while strengthening nursing measures, should be dealt with in a timely manner.

Acute subdural hematoma symptoms Common symptoms Deep coma coma disorder Increased intracranial pressure hardening

Acute subdural hematoma is associated with heavier brain contusion. Most of the clinical classifications are severe craniocerebral injury. The primary coma is deeper after injury. The complex smear period of the subdural hematoma is rare, and the expression of consciousness disorder is progressively worse. Less intermediate waking period, even if the degree of consciousness disorder was once improved, it was short-lived. As the cerebral palsy formed quickly and fell into a deep coma, on the basis of brain contusion, with the gradual formation of hematoma, cerebral palsy can be quickly formed into the deep Coma, compared with simple brain contusion, the increase of intracranial pressure is more significant, the patient's post-injury consciousness disorder is more serious, symptoms of increased intracranial pressure such as vomiting, agitation are more common; vital signs such as elevated blood pressure, increased pulse pressure difference, breathing And the pulse is slow, and the body temperature is increased.

In the early post-injury, the neurological focal signs may be generated due to damage of the brain functional area and compression of the hematoma, such as: central facial palsy and hemiplegia, aphasia, epilepsy, etc.; ipsilateral pupil appears when cerebellar incision occurs. Large, eyeball fixation, contralateral limb paralysis, treatment is not timely or ineffective, can rapidly deteriorate bilateral dilated pupils, cortical tonic and pathological respiration, into an endangered state, particularly acute intracranial hematoma is common in decelerating impact injury Caused by subdural hematoma, simple acute subdural hematoma mostly intermediate awake period, the disease progresses relatively slowly, local injury signs are rare, increased intracranial pressure and appearance of cerebellar incision and posterior performance of composite dura mater The hematoma is similar. If there are new signs in the observation process, the early signs of injury or the original positive signs are obviously aggravated, etc., the possibility of secondary hematoma in the brain should be considered.

According to the history of head trauma, the cause of injury and the mechanism of injury, the time of primary coma is longer or the disturbance of consciousness is deepening, and signs of increased intracranial pressure appear, especially those with early signs of nervous system, which should be highly suspected of acute hard. The possibility of subdural hematoma should be confirmed in time to confirm the diagnosis or assist in diagnosis. When there is a disturbance of consciousness and typical cerebellar incision, the most likely site of hematoma can be determined according to the injury mechanism and clinical manifestations. Hole exploration, if there is a hematoma, the early decompression of the liquid part is released.

Examination of acute subdural hematoma

The CT scan is the first choice for auxiliary examination. It can understand the condition of brain contusion and laceration, and whether there is subdural hematoma or X-ray examination of the skull. About half of the patients may have fractures, but the location is not important for epidural hematoma. Can only be used as a reference for analyzing damage mechanisms.

1. The incidence of skull fractures of the skull is lower than that of the epidural hematoma, which is about 50%, and the location of the hematoma is inconsistent with the fracture line.

2. CT scan can be completed quickly after the visit, which is characterized by crescent-shaped high-density shadow on the surface of the brain. Spotted hemorrhagic lesions can be seen in the medial cortex, cerebral edema is obvious, the ipsilateral ventricle is compressed and deformed, and the midline is moved to the side. Position is the current and most commonly used basis for diagnosis of craniocerebral injury and intracranial hematoma.

3. MRI can clearly show the extent and extent of hematoma and combined injuries, but it takes a long time, and people with conscious disabilities can not cooperate with the examination, and should not be used in patients with acute brain injury.

Diagnosis and diagnosis of acute subdural hematoma

For the diagnosis of acute subdural hematoma in children and the elderly, attention should be paid to the clinical manifestations. The symptoms of cerebral pressure in children appear earlier and heavier. Sometimes the brain contusion is not heavy but the brain edema or swelling is obvious. There are neurological deficits, more epilepsy, poor prognosis than adults, the elderly due to hardening of the arteries, brain atrophy, brain activity, so a slight head injury can also cause serious damage, so acute subdural hematoma is mostly a hemorrhagic compound Hematoma, often accompanied by intracerebral hematoma, although the brain edema reaction is not as heavy as young people, but the tissue repair ability is poor, slow recovery, more complications, and high mortality.

Differential diagnosis

1. Acute epidural hematoma The typical epidural hematoma is characterized by mild primary brain injury, transient dysfunction, intermediate awake period, and the extent of secondary coma in the morning and evening and vascular injury. It is related to the diameter of the injured blood vessel. During the development of the disease, severe headache, vomiting, restlessness, etc., and increased blood pressure, pulse and slow breathing, and other intracranial hypertension, CT scan primary brain injury is rare, under the skull It appears as a biconvex high-density zone.

2. Intracerebral hematoma acute subdural hematoma and intracerebral hematoma injury mechanism, clinical manifestations are very similar, intracerebral hematoma is relatively rare, the disease progresses slowly, CT, MRI can identify the two, confirmed.

3. Diffuse brain swelling With the increasing popularity of CT, the rate of acute traumatic diffuse brain swelling is getting higher and higher. Such patients can continue to increase their coma after injury, and they can also stun after a short time. After a few hours. Then coma and rapid increase, and more common in the top occipital part of the deceleration of the impact injury, simply based on the injury mechanism and clinical manifestations difficult to identify, CT scan showed one or more lobular edema swelling, scattered in the spotted hemorrhage, development The prognosis is very poor either quickly or without treatment.

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