Brain hematoma is a very dangerous phenomenon. It occurs due to the accumulation of blood in a certain area of the cranium, which occurred as a result of rupture of the vessel. A hematoma can cause hypertension. In addition, it presses on the brain centers, reducing their functionality. Therefore, treatment should be started immediately, otherwise a person is at risk of death. And now we should talk about what actions should be taken when a hematoma occurs.
Causes
The human brain is washed from all sides by cerebrospinal fluid - cerebrospinal fluid. It protects it from shaking and performs a cushioning function.
But if a severe bruise occurs, then the brain hits the cranial walls. And this is often accompanied by rupture of the blood vessels that are inside. This is the main reason why hematoma of the brain occurs. In addition, provoking factors are:
- Stroke (brain stroke).
- Malformation or aneurysm (pathological connection of arteries and veins).
- Sickle cell anemia, hemophilia, leukemia and other blood pathologies.
- Cysts and brain tumors.
- Autoimmune disorders.
- Liver disease.
- Hypertension of a chronic nature.
- Abuse of anticoagulants (substances that affect blood coagulation).
Depending on the cause, the symptoms come to light either immediately or after some time. A brain hematoma as a result of an impact, for example, begins to disturb a person in a couple of hours. But if the reason lies in any disease, then a lot of time will pass.
Symptoms
They cannot but alert a person. Symptoms of a brain hematoma are specific, and they manifest in a complex manner, almost all at once. Here is what overcomes a person:
- Nausea and vomiting.
- Headache.
- The difference in the size of the pupils.
- Severe drowsiness.
- Dizziness.
- Loss of speech or its slowness.
- Confusion.
- Weakness in the limbs, usually on one side of the body.
In the event that the narrow space between the skull and the brain is filled with a large amount of blood due to rupture of the vessel, then other, more serious symptoms appear. Namely:
- Lethargy. This is a condition in which a person is motionless and does not show any reactions to external irritation. Lethargy differs from coma in that it is easier to remove the patient from it.
- Cramps.
- Coma.
However, all of the above can be attributed rather to the consequences of a brain hematoma. And although the clinical picture of this phenomenon is almost always the same, by species it is different. Hematomas are classified by localization. And now each species should be considered separately.
Epidural hematoma
It is characterized by the accumulation of blood in the space between the hard cerebral membrane and the bones of the skull. It is in these cases that a person experiences impaired consciousness, intracranial hypertension and compression of the brain.
For diagnosis, they resort to MRI, CT, cerebral angiography, craniography and echo-EG. After carrying out all the studies necessary to confirm the diagnosis, they begin treatment. In these cases, it is surgical. The following activities are carried out:
- Craniotomy. A hole is made in his bone tissue to gain access to the underlying cavity.
- Removing brain hematoma.
- Search for a source of bleeding and its further elimination.
Is conservative treatment possible? Yes, but only if the epidural hematoma in the volume does not exceed 30-50 ml, is not accompanied by compression and does not cause progressive or severe symptoms.
However, such cases are very rare. After all, an epidural hematoma has a traumatic genesis. It arises from a blow with a hammer, a bottle, a stone, a stick, from a fall from a bicycle, a step or because of a blow to a corner. In this case, as a rule, the meningeal artery, veins, sinuses, etc. are affected, and in this case, the volume can in no way exceed 30-50 ml.
Subdural hematoma
It manifests itself in a local accumulation of blood between the arachnoid and hard membranes. In 40% of cases, this form of hematoma is diagnosed. As a rule, it arises as a result of a traumatic brain injury - in 22% of people with TBI it developed without fail.
Hematoma can be of three types:
- Sharp. Symptoms appear during the first three days after head injury.
- Subacute. Signs make themselves felt in the period from 3 days to 2 weeks, starting from the moment of injury.
- Chronic Onset of symptoms takes more than 2 weeks.
It should also be noted that subdural hematoma is both traumatic and non-traumatic. In the first case, the patient reveals a wound penetrating the skull. In the second, it is absent.
With the subdural form, you can do without removing the brain hematoma. Conservative therapy will be enough, but only if the person has not impaired consciousness, and the lesion itself in thickness does not exceed 1 cm.
Of course, surgery is contraindicated in patients who have fallen into a coma or stupor. But in the case of diagnosing a subacute or acute form, surgical intervention is indispensable. If a rapid increase in the dislocation syndrome is observed , then endoscopic removal of the hematoma is performed.
When stable, surgeons perform a wide craniotomy. This operation to remove the hematoma of the brain is carried out after an incision is made, 6-7 cm long. Without this, neither the accumulation can be eliminated nor the foci of crush.
Chronic hematoma, by the way, also requires surgical intervention. But in such cases, external drainage is carried out - the contents are removed through the tubes.
Subarachnoid hematoma
In 85% of cases, the cause of this lesion is a rupture of the aneurysm of the vessel. The main symptom is a sharp headache, which is similar to a blow to the head. It is accompanied by a pulsation in the occipital region. There may also be vomiting, and 6 hours after the injury, stiff neck begins to develop.
The hemorrhage is concentrated between the pia mater and the arachnoid in the subarachnoid space.
In this case, removal of a brain hematoma is indicated. The operation is performed after stabilization of the patient. If necessary, then artificial ventilation of the lungs and symptomatic treatment are performed.
Intracerebral hematoma
This is a limited accumulation of blood. If it is small, then it is realistic to get rid of it using conservative methods. Large accumulations have to be removed surgically, or resort to aspiration.
It should be noted that intracerebral formation can consist of both liquid blood and coagulated. In some cases, it contains detritus, a tissue breakdown product.
The amount of blood contained by the hematoma can vary from 1 to 100 ml. It is rapidly increasing - only 2-3 hours are enough after the bleeding begins.
This formation often becomes the cause of cerebral edema, displacement of its structures, the development of a dislocation syndrome and reflex spasm.
Ischemia often develops, and this is an additional damaging factor, which leads to the fact that pathological changes begin to spread far beyond the hematoma. In 14% of cases, the hematoma affects the ventricles of the brain.
If a person has several clusters during intracerebral hemorrhage, then only the largest of them is removed during the operation.
Intraventricular hematoma
This is the last view to be addressed. Intraventricular congestions are the rarest. They lead to the development of compression of the brain. Accumulations can fill both the entire ventricular system and individual cavities.
Typically, these hematomas are associated with a breakthrough of intracerebral hemorrhage. But there are other cases. Sometimes they arise due to a breakthrough of intracerebral hematomas. What it is? Accumulations of blood that develop at a young age (20-30 years) in people who are almost completely healthy.
The cause is usually arteriovenous aneurysms and angiomas. The place of their localization is the white matter of the semi-oval center of the frontal, occipital and parietal-temporal regions. At first, there may not be any symptoms, but then the hematoma makes itself felt. Clinical development begins with a sudden loss of consciousness, vomiting, and fever. If the formation is localized in the left hemisphere, then speech disorders occur.
However, it is worth returning to intraventricular congestions. They are usually accompanied by a bruised trunk and other serious injuries. That is why they are difficult to recognize in life.
But if the diagnosis was successful, then emergency treatment is carried out. To remove accumulations from the ventricular system, it is washed with a special solution of warm temperature, consisting of sodium chloride. But the operation does not end there. Then a ventriculotomy or encephalotomy is performed. Using these methods, it is possible to remove uncleaned blood clots.
Unfortunately, people with intraventricular congestions without surgery have virtually no chance of life. But if it was possible to timely carry out a radical elimination of the hematoma, then the prospects for saving their lives remain.
Medications
Well, as you could already understand, the operation to remove clusters is shown in most cases. It is very rarely possible to treat brain hematoma with drugs.
But if surgical intervention can be dispensed with, then one of the following is prescribed:
- Aminocaproic acid. This is a hemostatic agent, which is an inhibitor of fibrinolysis. It inhibits the action of plasmin, inhibits kinins and blocks the action of plasminogen activators.
- "Vikasol." Effective antihemorrhagic agent. Positive effect on blood coagulation.
- Aprotinin. Antenzyme preparation. It stops the shock states of any genesis.
- "Nifedipine." It is a calcium channel blocker. It has antihypertensive and antianginal effects. Reduces the flow of calcium ions into the smooth muscle cells of arteries, dilates blood vessels, reduces blood pressure and vascular resistance.
- Nimodipine. It has a positive effect on the tone of the vessels of the brain, as well as anti-migraine, normotimic, nootropic and vasodilating effects. Effective in the prevention of vasospasm.
- Mannitol. This is an osmotic diuretic that increases the osmolarity of plasma, which causes the movement of fluid from the tissues into the vascular bed. Its reception is able to prevent cerebral edema.
In addition to the above, to relieve the symptoms of a brain hematoma, the doctor may prescribe antiemetic, sedative, anticonvulsant drugs, as well as analgesics.
The consequences of the operation
Unfortunately, it will take a long time to recover after removing the brain hematoma. The consequences can be very different, and here are just a few of them:
- Asthenia. It manifests itself in chronic fatigue, sleep disorders, depression, as well as in hypersensitivity to changes in atmospheric pressure.
- Speech Disorders. A person will have problems with counting, writing, and reading. It will be difficult for him to understand what other people are talking to him.
- Tearfulness, increased irritability, sudden mood swings, causeless fear or aggression.
- Psychosis and neurosis.
- Problems with perception. A person with normal vision may not be aware of what exactly he sees.
- Cognitive impairment, manifested in impaired thinking and memory.
- Deterioration of mental activity.
- Paralysis, weakness in the limbs, impaired coordination.
- Post-traumatic convulsions.
- Uncontrolled bowel movements and urinary incontinence.
- Violation of swallowing function.
- The development of traumatic dementia.
Unfortunately, the most serious consequence of brain hematoma surgery and the disease itself in particular is death. It is 50-90%. In elderly patients, this indicator is the highest.
Mortality is caused not so much by cerebral hemorrhage as by traumatic damage to its tissues.
There may be other causes of death. Cerebral edema, for example, secondary cerebral ischemia, dislocation of brain structures.
The threat of death remains even if the operation was successful. After a brain hematoma, there will be consequences, and dealing with them is not easy. The most important thing is to constantly be under medical supervision. And, of course, follow the recommendations of doctors.
Rehabilitation
To avoid the effects of a brain hematoma, as well as speed up the recovery process after surgery, a person should adhere to such measures:
- At first, observe bed rest.
- Sleep a lot, relax during the day.
- Maintain a balanced diet. You only need healthy foods that are enriched with vitamins, as well as macro- and microelements.
- Return to normal activities slowly, gradually.
- Exercise accuracy and caution. Repeated head injuries must not be allowed.
- Do not engage in active sports until full recovery.
- Before you drive, you should consult a doctor. After such a severe injury, many patients have a disturbed reaction.
- Do not take medications other than those prescribed by your doctor.
- Stop drinking alcohol.
Brain hematoma is a serious and life-threatening pathology. This injury is much easier to prevent than to cure. Therefore, it is very important to take responsibility for your health and protect it.