Acute and subacute subdural hematomas

Introduction to acute and subacute subdural hematoma Acute and subacute subdural hematoma refers to a subdural hematoma after trauma, which is acute (symptoms appear within 3 days after injury) or subacute (the symptoms appear within 4 to 3 weeks after injury). The incidence of acute subdural hematoma in the acute (3 days) accounted for 70%, and subacute (4 to 21 days) accounted for about 5%. The causative factors of the two were basically the same as the source of bleeding, and they all occurred in the frontal area. The speed of clinical course development varies according to the severity of the brain damage, the amount of bleeding and the ability of individuals to compensate. basic knowledge Sickness ratio: 0.0004% Susceptible people: no specific population Mode of infection: non-infectious complication:

Causes of acute and subacute subdural hematoma

Acute and subacute subdural hematoma are caused by rupture of cortical blood vessels caused by brain contusion, so they are all complex subdural hematomas. The difference is only slightly different in the course of the disease. The factors and the pathology of the injury are similar: that is, the brain contusion and laceration caused by the accelerated injury, the hematoma is mostly on the same side; and the hemorrhagic brain contusion caused by the deceleration injury is often on the contralateral side.

One side of the occipital force is constant on the contralateral side, a complex subdural hematoma occurs in the anterior part of the ankle, and even a hematoma in the brain is concurrent; the midline of the occipital iliac is easy to cause bilateral frontal poles, hemorrhoids at the tip of the sacral head; When hitting, the injured side can cause a compound subdural hematoma, that is, a subdural hematoma; when the head side is collided or falls, the ipsilateral side is mostly a combined subdural hematoma or epidural hematoma, and the contralateral side can be To simple and / or complex subdural hematoma; in addition, the forehead suffered violence, whether it is a blow or a collision, hematoma often in the forehead, rarely occurs in the occipital, while the elderly often cause unilateral or double Lateral simple subdural hematoma.

Acute and subacute subdural hematoma prevention

The disease is a traumatic disease, no preventive measures, pay attention to safety, avoid trauma, once the brain trauma should be diagnosed as early as possible, early treatment.

Acute and subacute subdural hematoma complications Complication

One side of the occipital force is constant on the contralateral side, a complex subdural hematoma occurs in the anterior part of the ankle, and even a hematoma in the brain is concurrently present.

Symptoms of acute and subacute subdural hematoma Common symptoms Hematoma formation consciousness disorder Cerebral palsy Coma vascular sclerosis Deep coma Increased intracranial pressure

Most of the acute cases are complex subdural hematoma, so the clinical manifestation is similar to brain contusion and laceration. The difference is that the progressive intracranial pressure is more significant, which exceeds the degree and speed of brain edema reaction after general brain injury, and the patient's post-injury consciousness. Obstacles are more prominent, often manifested as persistent coma, and progressive deterioration, less intermediate waking period, even if the degree of disturbance of consciousness has once improved, it is also short-lived, with the formation of cerebral palsy quickly into deep coma, subacute Because the primary brain contusion and laceration is lighter and the bleeding rate is slightly slower, the process of hematoma formation to brain compression is slightly longer, so that the cranial volume product compensatory force can be exerted. Therefore, there is often a middle waking period, but the mind is restored. The degree is not as clear and awake as an epidural hematoma.

1. Symptoms of increased intracranial pressure: acute, mainly manifested by deepening of consciousness disorder, prominent changes in vital signs, and early signs of cerebellar incision; subacute, often showing headache, increased vomiting, restlessness And the progressive deterioration of consciousness, when the cerebral palsy is formed, it turns into a coma.

2. Focal signs: In the early stage after injury, some brain functional areas may be involved due to brain contusion, and there are corresponding signs after injury, such as hemiplegia, aphasia, epilepsy, etc.; if new signs appear during the observation, Those who have not been seen in the early post-injury or whose original positive signs are significantly aggravated should consider the possibility of secondary hematoma in the brain.

3. In addition, the diagnosis of acute subdural hematoma in children and the elderly should pay attention to its clinical manifestations: children with brain pressure symptoms appear earlier, heavier, sometimes brain contusion is not heavy but brain edema or swelling Obviously, it is easy to have nerve function defects, more epilepsy, and the prognosis is worse than that of adults; the elderly suffer from hardening of the arteries, brain atrophy, and brain activity, so minor head injuries can also cause serious damage, so acute subdural hematoma It is a hemorrhagic compound hematoma, often accompanied by intracerebral hematoma. Although the cerebral edema reaction is not as heavy as that of young people, the tissue repair ability is poor, recovery is slow, complications are high, and mortality is high.

Examination of acute and subacute subdural hematoma

1. Mainly relying on CT scanning, it can not only understand the condition of brain contusion and laceration, but also whether there is subdural hematoma; it shows high density and new moon shadow on CT scan.

2. X-ray examination of the skull, about half of the patients may have fractures, but the location is not important for epidural hematoma, and can only be used as a reference for analyzing the mechanism of injury.

3. Magnetic resonance imaging (MRI) can not only directly display the advantages of the degree and extent of injury, but also have a unique effect on the hematoma in the treatment of CT and other density periods. Because of the release of methemoglobin after erythrocyte lysis, T1 and T2 all show high signals. Therefore, it has its special advantages.

4. In addition, brain ultrasound or cerebral angiography, the value of the subdural hematoma also has a side or positioning.

Diagnosis and diagnosis of acute and subacute subdural hematoma

diagnosis

Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.

Differential diagnosis

1. Chronic subdural effusion:

Also known as dural hydromassoma, most of which are related to trauma, and are very similar to chronic subdural hematoma. Even the author diagnoses subdural hematoma is the cause of chronic hematoma (Yamada, 1980), the diagnosis mainly depends on CT or MRI, otherwise It is difficult to distinguish before.

2. Cerebral hemisphere occupying lesions:

In addition to hematoma, there are brain tumors, brain abscesses and granuloma and other space-occupying lesions, which are easily confused with chronic subdural hematoma. The difference is mainly in the history of no head trauma and more obvious signs of localized neurological deficits. CT, MRI or cerebral angiography is also required.

3. Normal intracranial pressure hydrocephalus and brain atrophy:

These two lesions are similar to each other and are similar to chronic subdural hematoma. There are intelligent declines and/or mental disorders. However, there is no increase in intracranial pressure in both lesions, and imaging examination has enlarged ventricles. The width and brain atrophy are characterized by it.

4. Identification of acute extradural hematoma and acute subdural hematoma:

Clinical features: acute epidural hematoma

Acute subdural hematoma: the focus is on the same side of the force in the opposite side of the force, the ipsilateral brain contusion and laceration are light, multiple in the impact site, and most of the skull fractures in the heel site have about half of the hematoma and fracture relationship The vast majority of the ipsilateral primary conscious disturbances on the ipsilateral side are more lighter and heavier. The middle consciousness is more likely to be fully awake, and it is not easy to fully awake. Subarachnoid hemorrhage is less, lighter, and range. wide.

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