Epidural hematoma

Description:

Epidural hematoma — the traumatic hemorrhage which is located between the internal surface of bones of a skull and a firm meninx and causing a local and general compression of a brain.

Symptoms of the Epidural hematoma:

The epidural hematoma is, as a rule, localized within one-two shares of a brain. Its favourite arrangement — temporal, temporoparietal, temporal and frontal, temporal and basal areas; diameter of an epidural hematoma usually makes 7 — 8 cm.
The fact that its central part is thicker (2 — 4 cm), than peripheral departments is characteristic of an epidural hematoma. Representing the incompressible weight consisting of liquid blood and its parcels, the epidural hematoma otdavlivat the subject firm meninx and substance of a brain, forming a dent according to the form and size. The characteristic and the most often revealed bleeding point at an epidural hematoma are the injured average shell arteries and its branches, sometimes the shell veins, sine and vessels diply.

Clinic. Allocate 3 main options of a current of acute EG:

Classical option with the developed light interval. Meets often. After ChMT (usually a bruise of a brain of easy or average degree) which was followed by a short loss of consciousness there is its complete recovery or there is only a moderate devocalization. The victim notes a moderate headache, the general weakness, dizziness. The game - and retrograde amnesia comes to light. The moderate asymmetry of nasolabial folds, an anizorefleksiya, a spontaneous nystagmus, moderate meningeal symptoms and other signs which are keeping within a clinical picture of easy ChMT can be found. Rather safe state at acute EG proceeds from several tens mines to several hours. Then there is strengthening of headaches, sometimes to intolerable, causing psychomotor excitement of the patient. There is vomiting which can repeat. The person becomes hyperemic. The general condition of the patient considerably worsens, develops drowsiness, there is a secondary switching off of consciousness, is frequent with consecutive change of moderate devocalization by deep devocalization, a sopor and a coma. Along with it bradycardia, and also a tendency to increase in the ABP is shown. Sometimes the coma develops so promptly that intermediate stages of switching off of consciousness are not caught. Already during the period preceding partial switching off of consciousness at patients with EG the focal neurologic symptomatology begins to accrue. Most often kontralayeralny brakhiofatsialny insufficiency goes deep (to degree of deep paresis). There is an anisocoria, originally with a moderate mydriasis on the party of a hematoma, and then with a limit mydriasis and lack of reaction of a pupil to light. Sometimes at EG development of symptoms of a local prelum of a brain can advance considerably emergence of signs of its general compression. When switching off of understanding reaches a coma, disturbances of the vital functions become menacing.
Option with the erased light interval. Meets quite often. The staging of a clinical current of EG described in classical option remains, but in these cases character and expressiveness of symptomatology have essential differences. Usually ChMT is heavy, primary loss of consciousness reaches coma degree. The rough gnezdny symptomatology, and also these or those disturbances of the vital functions caused by primary damage of substance of a brain comes to light. Further, however (in several hours), coma is replaced by a sopor, deep devocalization with a possibility of the minimum verbal contact with the patient. In this period it is possible to establish existence of a headache, most often by means of its objektiviziruyushchy signs (reaction to skull percussion, groans with a head skhvatyvaniye hands, searches of antalgichesky situation, psychomotor vozbuzhdenny other). The erased light interval through various terms (minutes, hours, sometimes days) is replaced by repeated deepening of disturbance of consciousness (devocalization passes into a sopor, a sopor — in a coma). It is followed by increase of motive excitement, vomiting, emergence or deepening of disorders of the vital functions, development of a gormetoniya, heavy vestibulo-oculomotor disturbances and other trunk symptomatology. Also the focal symptomatology amplifies: the hemiparesis up to paralysis goes deep, there is a unilateral mydriasis or the being available mydriasis becomes limit.
Option without light interval. Meets rather seldom. Those cases of a current of acute EG when even the erased light interval after an injury anamnesticly, at observation in a hospital is not established concern to him.
Usually it is the patients who got a severe injury with the multiple injuries of a skull and brain accompanying a hematoma. At them it is stated soporous or coma from the moment of an injury without any elements of remission up to operation or death of the patient.
The clinical picture of subacute EG during the period following directly an injury is similar that at classical option of acute EG. But the light interval coming in 10 — 20 min. after an injury at subacute EG, unlike acute, proceeds not several hours, but several days, in some cases to 10 — 12 days. In this period the general condition of the patient usually does not inspire serious fears, the vital functions are a little changed, only the tendency to bradycardia and increase in the ABP can be noted. Focal symptomatology it is long remains softly expressed. Consciousness of the patient clear or is available moderate devocalization. However gradual development of disorder of consciousness is characteristic further, sometimes with wavy deepening of its switching off before deep devocalization and rather bystry recovery it is spontaneous or under the influence of dehydration. Usually as steadily progressing, and undulating disturbance of consciousness is preceded by strengthening of a headache and moderate psikhomorny excitement. At a subacute current of EG, unlike acute, such objective sign of a compression of a brain as developments of stagnation on an eyeground can develop. Chronic EG meet seldom.
EG of purely frontal or parietal localization often differ in rather slow development of a compression syndrome and softness of focal symptomatology. At EG of a pole of a frontal lobe the clinical picture is characterized by subacute development of a compression of a brain with domination of a syndrome of the shell irritation and intracranial hypertensia at scarcity of focal neurologic symptomatology: psychopathological disturbances have frontal coloring. At EG of parasagittal localization in focal symptomatology against the background of a subacute current of a compression syndrome pyramidal disturbances among which contralateral paresis of foot is most expressed prevail. EG of a pole of an occipital share is characterized by gradual development of all-brain symptomatology in combination with a contralateral gomonimny hemianopsia.

Reasons of the Epidural hematoma:

The epidural hematoma develops at an injury of the head of various intensity, a thicket medium-weight. Influence of the injuring agent the snebolshy area of the appendix on the motionless or slow-moving head (blow by a stick, a bottle, a stone, the hammer etc.) or heading, being in the slow movement, about a motionless subject (is the most typical when falling on the street, on a ladder, from the bicycle, owing to a push moving transport, at blow about a door jamb, about a shelf corner, etc.). The side surface of the head, preferential temporal and nizhnetemenny areas happens a place of application of the injuring subject more often. The temporary local deformation of a skull which arose at the same time, it is frequent with an impression change and a rupture of vessels of a firm meninx, creates premises for formation of an epidural hematoma in the field of blow. Frequency of occurrence of an epidural hematoma in relation to all cases of ChMT fluctuates
within 0,5 — 0,8%. The volume of an epidural hematoma varies within 30 — 250 ml, most often makes 80 — 120 ml.

Treatment of the Epidural hematoma:

At establishment of the diagnosis of EG urgent surgical intervention is usually shown. In the field of an arrangement of EG make osteoplastic or resection trepanation. After formation of a bone window by means of an aspirator, the pallet or a spoon completely delete liquid blood and parcels. After removal of EG find a bleeding point and carry out a careful hemostasis. Operation if there is no need for a decompression, finish with laying of a bone rag into place and layer-by-layer sewing up of a wound. Sometimes perhaps spontaneous drainage of EG through cracks of adjacent bones in subgaleal space; in such cases of rather puncture emptying of the blood accumulating under an aponeurosis. At small on EG volume (to 30 ml) and lack of the expressed dislocation phenomena in the conditions of KT-control it is admissible to abstain from surgical intervention. Through 3 — 4 weeks — against the background of conservative treatment — occurs rassasyvany EG.