The brain consists of several shells. 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 shell and the brain. In this case, the victim is diagnosed with subdural hemorrhage. It is about this pathology that we will discuss in today's article.
Damage mechanism
Subdural hemorrhage is usually preceded by trauma. A hematoma forms at the site of bleeding, which is growing rapidly. It carries a potential threat of damage to brain tissue, which are sensitive to this kind of exposure. The consequence of these processes is the occurrence of deviations of a neurological nature. Large-scale bleeding often leads to death.
Separately, it is necessary to consider the chronic form of subdural hematoma. It occurs if the previous hemorrhage did not have time to resolve. The hematoma is covered with its own membrane, into which blood vessels can grow. 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 that have formed by this type.
Concretizing the above facts, it can be argued that subdural hemorrhage in the brain develops as a result of damage to cortical and stony vessels. In rare cases of pathology, a violation in the work of the Galen vein or a group of arteries associated with it is preceded.
Causes of pathology
The causes of subdural hemorrhage are quite diverse. Among them, the most common are the following:
- Car accidents (a hit on a “torpedo” or dashboard). The risk group includes front seat passengers who do not use seat belts.
- Fall on the head of icicles and blocks of ice in the winter season.
- Sports injuries.
- Head injuries at work if safety precautions are not followed.
- Household fights.
The listed reasons belong to the category of traumatic. It is important to understand that a hematoma develops gradually in these cases. The larger the damaged vessel, the more intense the hemorrhage and the more characteristic clinical picture.
Significantly less often, the violation occurs against the background of vascular pathologies of the brain. Among them should be attributed hypertension and arterial aneurysm. In some cases, the occurrence of a hematoma is due to the intake of anticoagulants. These factors cause non-traumatic subdural hemorrhage.
Classification principles
The pathology described in the article is usually classified according to the rate of development of primary symptoms. There are three forms of hemorrhage:
Consider what each of the options is:
- Acute subdural hemorrhage develops within 1-2 days from the moment of injury. The main cause of the appearance of a hematoma is considered to be a heavy and strong effect on the brain.
- In a subacute form, from 4 days to several weeks can elapse from the moment of damage to the appearance of the first symptoms. The traumatic effect is not so strong. The caliber of the affected vessel is not large, so the bleeding is insignificant.
- The timing of the manifestation of the chronic form varies from two weeks to several months or even years. If we consider trauma as a trigger for the development of a hematoma, then in this case it plays a secondary role. Most often, a chronic form of hemorrhage is a consequence of vascular diseases of the brain.
The specific form of the disorder determines the primary symptoms.
Clinical picture
Subdural hemorrhage is characterized by the fact that symptoms occur with the exact alternation of several phases.
Immediately after a traumatic effect, a person loses consciousness. Such a violation is due to the reaction of the body to acute and sudden pain, a 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 supplemented by retrograde amnesia - a short-term memory loss for events preceding the injury.
The second phase is characterized by improved well-being. Not every person after receiving damage attentively feels well to visit a doctor. Such neglect of one's own health can lead to more serious injuries. We are talking about those situations when 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 cerebral category includes such disorders that can be observed with 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 supplemented by disorientation in time and space - the patient has difficulties with determining the date, location. A headache appears once at the time of the injury, then weakens and increases with a new intensity in the third phase.
Signs indicating damage to the meninges can be attributed to meningeal manifestations of the pathology. 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 signs are absent or weak, the diagnosis of subdural cerebral hemorrhage is not confirmed.
Focal symptoms are represented by one-sided expansion of the pupil, while its response to light decreases sharply. Doctors sometimes fix a stupor in a victim - severe depression of consciousness. In especially serious cases, a coma occurs.
Features of pathology in children
Subdural hemorrhage in newborns is common enough. It is a consequence of intracranial birth injuries and accounts for approximately 40% of the number of intranatal pathologies. Among its main reasons, doctors note the following:
- large fruit;
- the use of intracavitary obstetric forceps;
- fast and swift delivery;
- leg / buttock presentation.
Suspecting a child’s health problems is very easy. All the unconditioned reflexes of the baby are in a depressed state. He is not able to take breasts, swallow. Squeezing the hematoma of the brain stem provokes the expansion of the pupils, convulsions. These symptoms appear in the first three days after childbirth.
Diagnostic Methods
After any traumatic brain injury, seek qualified help. Do not risk your health and ignore the initial signs of hemorrhage. Diagnosis of the pathology is based on the collection of anamnesis and questioning of the patient. It is important for the doctor to know all the information about the nature of the injury, the order in which clinical symptoms appear.
The most complete information about the location of the hematoma can be obtained after computed tomography. MRI is considered no less informative. If traumatic subdural hemorrhage is suspected, it is strictly forbidden to carry out a lumbar puncture. This procedure involves the collection of cerebrospinal fluid through a special needle. Its consequences may be irreversible.
Treatment options
After confirming the diagnosis, the patient is immediately hospitalized. Subdural hemorrhage is a serious pathology. Therefore, it is necessary to proceed to its treatment immediately. Only in this case can we hope for a favorable forecast.
To eliminate the violation, surgical and conservative methods of therapy are used. The latter option is used in the case of small sizes of hematoma, the absence of obvious progression. Patients are prescribed anti-edematous drugs, medications to improve blood circulation and brain metabolism. Also shown is the intake of vitamins and analgesics. Such treatment is recommended for elderly patients who are diagnosed with acute, non-traumatic subdural hemorrhage.
Most cases of pathology are subject to surgical intervention. During the operation, an autopsy is performed (trepanation) , followed by removal of the spilled blood. The final stage is washing the cavity with physiological saline, restoring the integrity of the cranial box and installing special drainage.
As for young patients, they are trying to treat them with medication. The lack of positive dynamics is the reason for the operation.
Consequences and prognosis for recovery
The occurrence of hemorrhage is accompanied by a displacement of the brain and an infringement of its stem structures. The development of pathology usually occurs against the background of severe skull injuries, so the prognosis in most cases is unfavorable. However, the final result depends on the time of going to the doctor and the correctness of the selected treatment. If the victim managed to operate within 6 hours after the injury, recovery occurs in 80% of cases. In addition, the prognosis is influenced by the age of the patient, the presence of somatic disorders and the volume of the hematoma.
Complicated subdural hemorrhage, the consequences are not very favorable. Typically, patients with this diagnosis become disabled or even die.