Головной мозг состоит из нескольких оболочек.The most durable of them is outdoor. For this reason, it is also called solid. Quite often, various head injuries lead to bleeding between the outer sheath and the brain. In this case, the victim is diagnosed with "subdural hemorrhage." It is about this pathology that will be discussed in today's article.
Damage formation mechanism
The appearance of subdural hemorrhage is usuallypreceded by injury. A hematoma forms at the site of bleeding and rapidly expands. It carries the potential threat of damage to brain tissues that are sensitive to this kind of exposure. The consequence of these processes is the occurrence of neurological abnormalities. Large-scale bleeding is often fatal.
Separately, it is necessary to consider the chronic form.subdural hematoma. It occurs if the previous hemorrhage did not have time to resolve. The hematoma is covered by its own membrane into which blood vessels can sprout. Against the background of an unstable state, these elements often burst, which contributes to the repeated growth of damage. Doctors have recorded repeated cases of the formation of giant hematomas, formed on this type.
Specifying the above facts canto assert that the subdural hemorrhage in the brain develops as a result of damage to the cortical and crazy vessels. In rare cases, the pathology is preceded by a malfunction of the vein of Galen or a group of arteries associated with it.
Causes of pathology
The causes of subdural hemorrhage are quite diverse. Among them, the most common are the following:
- Car accidents (hit on the "torpedo" or dashboard). The risk group includes passengers in the front seats who do not use seat belts.
- Fall on the head of icicles and blocks of ice in the winter season.
- Sports injuries.
- Damage to the head in production in case of non-compliance with safety regulations.
- Household fights.
The reasons listed are categorized.traumatic. It is important to understand that the hematoma develops gradually in these cases. The larger the damaged vessel, the more intense the hemorrhage and the faster the characteristic clinical picture.
Значительно реже нарушение возникает на фоне vascular pathologies of the brain. These include hypertension and arterial aneurysm. In some cases, the occurrence of hematoma is due to the use of anticoagulants. These factors cause non-traumatic subdural hemorrhage.
Principles of classification
The pathology described in the article is usually classified according to the rate of development of the primary symptoms. Three forms of hemorrhage are distinguished:
- acute;
- subacute;
- chronic.
Consider what each of the options represents:
- Acute subdural hemorrhage develops within 1-2 days from the moment of injury. The main cause of hematoma is considered a heavy and strong effect on the brain.
- Subacute from injurybefore the first symptoms appear, it can take from 4 days to several weeks. The traumatic impact is not so severe. The caliber of the affected vessel is not large, so the bleeding is insignificant.
- The timing of the manifestation of the chronic form varies fromtwo weeks to several months or even years. If we consider the injury as a trigger for the development of hematoma, then in this case it plays a secondary role. Most often the chronic form of hemorrhage is a consequence of vascular diseases of the brain.
The specific form of the violation determines the primary symptoms.
Clinical picture
Subdural hemorrhage is characterized by the fact that the symptoms manifest themselves with the exact alternation of several phases.
Immediately after the traumatic impact of a personlosing consciousness. Such a violation is due to the body's reaction to acute and sudden pain, stress factor. Then the patient comes to his senses and begins to complain of weakness and a stunned state. In some cases, the clinical picture is complemented by retrograde amnesia - short-term memory loss for events preceding the injury.
The second phase is characterized by improvement.well-being. Not every person after receiving damage is attentive to the state of health to visit a doctor. This neglect of one’s own health can lead to more serious injuries. We are talking about those situations where the victim gets behind the wheel of a car or continues to work.
The third phase is determined by the appearance of cerebral, focal and meningeal symptoms. These manifestations will be described below.
Cerebral, meningeal and focal symptoms
The category of cerebral include suchdisorders that can be observed in any other disorders. However, their appearance indicates a fairly serious brain damage. First of all, the victims have a severe headache. A person can become apathetic and indifferent to everything that happens. The clinical picture is often complemented by disorientation in time and space - the patient has difficulty in determining the date, location. The headache appears at the moment of injury, then weakens and grows with a new intensity in the third phase.
By meningeal manifestations of pathology include signs indicating damage to the meninges. Among them are:
- headache;
- vomiting that is not caused by food intake;
- positive meningeal signs.
Such symptoms are often observed in other disorders. If cerebral symptoms are absent or weakly expressed, the diagnosis of “subdural hemorrhage of the brain” is not confirmed.
Focal symptoms are unilateral.expansion of the pupil, while dramatically reducing its response to light. Sometimes, the victim's doctors fix a stupor - severe depression of consciousness. In especially serious cases, coma occurs.
Features of pathology in children
Subdural hemorrhage in newbornsoccurs quite often. It is a consequence of intracranial birth injuries and accounts for approximately 40% of the number of intrapartum pathologies. Among its main reasons, doctors note the following:
- large fruit;
- use of intracavitary obstetric forceps;
- fast and rapid delivery;
- foot / gluteal previa.
To suspect a child’s health problems is veryeasy. All the unconditioned reflexes of the baby are in a depressed state. He is not able to take the breast, swallow. Squeezing hematoma of the brain stem provokes pupil dilation, convulsions. These symptoms appear in the first three days after birth.
Diagnostic Methods
After any traumatic brain injury is necessarySeek qualified help. You should not risk your health and ignore the initial signs of hemorrhage. Diagnosis of pathology is based on the collection of anamnesis and patient survey. It is important for the physician to know all the information about the nature of the injury, the order in which the clinical symptoms appear.
The most complete information on the localization of hematomacan be obtained after computed tomography. MRI is considered to be no less informative. If you suspect a traumatic subdural hemorrhage is strictly forbidden to carry out lumbar puncture. This procedure involves the collection of cerebrospinal fluid by means of a special needle. Its consequences may be irreversible.
Treatment options
After confirming the patient's diagnosis immediatelyhospitalized. Subdural hemorrhage is a serious pathology. Therefore, it is necessary to proceed to its treatment immediately. Only in this case, we can hope for a favorable outlook.
Для устранения нарушения используются оперативные and conservative therapies. The latter option is used in the case of small hematoma size, the absence of obvious progression. Patients are prescribed anti-edema drugs, medicines to improve blood circulation and brain metabolism. Also shown is the intake of vitamins and analgesics. Such treatment is recommended for elderly patients diagnosed with acute, non-traumatic subdural hemorrhage.
Most cases of pathology are subject tosurgical intervention. During the operation, an autopsy of the skull (trepanation) is performed, followed by removal of the spilled blood. The final stage is washing the cavity with saline, restoring the integrity of the skull and installing a special drainage.
As for the young patients, they are trying to treat them with drugs. The lack of positive dynamics is the reason for the operation.
Consequences and prognosis for recovery
The occurrence of hemorrhage is accompaniedthe displacement of the brain and the infringement of its stem structures. The development of pathology usually occurs on the background of severe damage to the skull, so the prognosis in most cases is unfavorable. However, the final result depends on the time of treatment to the doctor and the correctness of the selected treatment. If the victim was operated on within 6 hours after the injury, recovery occurs in 80% of cases. In addition, the prognosis is influenced by the patient's age, the presence of somatic disorders and the amount of hematoma.
Complicated subdural hemorrhage has not the most favorable consequences. Usually, patients with such a diagnosis become disabled or die at all.
