Subdural hematoma

Description:

Subdural hematoma - hemorrhage which is located between a firm and web meninx  and, as a result, causing the general or local compression (prelum) of a brain. The subdural hematoma can develop at an injury of the head of various weight.

Symptoms of the Subdural hematoma:

Options of a course of ACUTE subdural hematomas:

Classical option. Meets rather seldom. Three-phase change of consciousness (primary loss of consciousness, the developed light interval and secondary switching off of consciousness) is observed. Primary loss of consciousness occurs right after an injury and is, as a rule, short. Further the following light interval lasts of 10-20 min. till several o'clock. Patients complain of headaches, dizziness, retrograde amnesia (impossibility to remember the events preceding an injury) is observed. Further there is a devocalization deepening,  there is an increased drowsiness or psychomotor excitement. Patients are inadequate, the headache amplifies, there is repeated vomiting. Strengthening of focal symptomatology is observed (  the gomolateralny mydriasis, contralateral pyramidal insufficiency and disorders of sensitivity develops). Parallel to switching off of consciousness the secondary stem syndrome with bradycardia, increase in the ABP, change of a respiratory rhythm, bilateral vestibulo-oculomotor and pyramidal disturbances, tonic spasms develops.
Option with the erased light interval. It is observed more often than classical. The subdural hematoma in this case develops owing to a heavy bruise of a brain. Primary loss of consciousness can be at the level of a coma, the focal and trunk symptomatology caused by primary damage of substance of a brain is expressed. Meningeal symptoms are defined.  During from several minutes to 1-2 days, the erased light interval is replaced by a repeated loss of consciousness to a sopor or a coma, the hemiparesis accrues, epileptic seizures can develop.
Option without light interval. It is observed more often than the first and second options. The subdural hematoma develops owing to multiple injuries of a skull and brain. A condition of these patients throughout treatment before operation, as a rule, without improvement

Options of a course of SUBACUTE subdural hematomas:

The classical option (typical three-phase current) meets most often.
Option without primary loss of consciousness (meets quite seldom). Results, as a rule, from easy ChMT.
The option with the erased light interval (meets more often than the second option) at which the maximum enlightenment of consciousness after its primary loss does not go beyond deep devocalization; meets quite often.

Reasons of the Subdural hematoma:

The injuring influence of the small square at the limited site of the head is necessary, as a rule. It leads to a local bruise of a brain and a rupture of pialny or cortical vessels. Characteristic of subdural hematomas is formation of hemorrhage and on the opposite side from application of the injuring force (the antiblow mechanism).

The subdural hematoma, as a rule, has volume from 30 to 250 ml (more often than 80 — 150 ml). It  freely spreads on a subdural space, occupying  more extensive area in comparison with epidural hematomas. Sizes of these hemorrhages (most often): width is 10 x 12 cm, blood layer thickness: 1 — 1,5 cm.

Education  is in most cases connected with a rupture of pialny veins in the place of their falling into an upper arrow-shaped sine, is more rare — in a sfenopariyetalny and cross sine. Quite often a source of a subdural hematoma are the damaged superficial vessels of a hemisphere, first of all — cortical arteries.

Treatment of the Subdural hematoma:

Existence of a subdural hematoma provides urgent surgical intervention. Carry out osteoplastic or resection trepanation. In an educated trepanation window the intense cyanotic not pulsing or inertly pulsing firm meninx which is podkovoobrazno opened with the basis turned to an upper arrow-shaped sine eminates. Accumulation of liquid blood and its clots delete by means of the pallet, a stream of isotonic solution of sodium of chloride and wet cotton plugs. Carry out a careful hemostasis (elimination of a bleeding point). After implementation of the above-stated actions  the firm meninx is taken in, laying the bone rag into place and is layer-by-layer recovered by skull covers. For outflow of blood and fabric separated establish a drainage, approximately for days. There is also endoscopic technique of removal of a subdural hematoma (through a small opening in a skull). At small hemorrhages up to 30 ml and lack of the expressed dislocation phenomena in the conditions of constant clinical and KT/MPT of control is admissible to abstain from an operative measure. Within 3 - 4 weeks, against the background of conservative treatment usually there is a rassasyvaniye.