The brain consists of several shells. The most durable of them is the outer one. 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 this pathology that will be discussed in today's article.
Mechanism of damage generation
Subdural hemorrhage is usually preceded by trauma. At the site of bleeding, a hematoma is formed, which is growing at a rapid pace. It carries a potential threat of damage to brain tissues, 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 is often fatal.
Separately, it is necessary to consider the chronic form of subdural hematoma. It occurs inin the event that 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 re-growth of damage. Doctors have recorded repeated cases of the formation of giant hematomas formed according to this type.
Specifying the above facts, it can be argued that subdural hemorrhage in the brain develops as a result of damage to the cortical and stray vessels. In rare cases, pathology is preceded by a malfunction in 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 a "torpedo" or dashboard). The risk group includes front-seat passengers who do not use seat belts.
- Icicles and blocks of ice fall on the head in the winter season.
- Sports injuries.
- Injuries to the head at work due to non-compliance with safety regulations.
- Domestic fights.
The listed causes are classified as traumatic. It is important to understand that the hematoma develops in these cases gradually. The larger the damaged vessel, the more intense the hemorrhage and the faster the characteristic clinical picture appears.
Significantly less often, a violation occurs against the background of vascular pathologies of the brain. Among them should be includedhypertension and arterial aneurysm. In some cases, the occurrence of hematoma is due to the intake 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 primary symptoms. There are three forms of hemorrhage:
- spicy;
- subacute;
- chronic.
Let's look at what each option is:
- Acute subdural hemorrhage develops within 1-2 days of injury. The main cause of a hematoma is considered to be a severe and severe effect on the brain.
- In the subacute form, from the moment of injury to the onset of the first symptoms, it can take from 4 days to several weeks. The traumatic impact is not so strong. The caliber of the affected vessel is not large, so the bleeding is negligible.
- 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, the chronic form of hemorrhage is the result of vascular diseases of the brain.
The specific form of the disorder determines the primary symptomatology.
Clinical picture
Subdural hemorrhage is characterized by the fact that the symptoms appear with an exact alternationmultiple phases.
Immediately after a traumatic impact, a person loses consciousness. Such a violation is due to the body's reaction 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 loss of memory for events preceding the injury.
The second phase is characterized by an improvement in well-being. Not every person, after receiving an injury, is attentive to well-being in order to visit a doctor. This neglect of one's own he alth 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 discussed below.
Cerebral, meningeal and focal symptoms
The category of cerebral disorders includes such disorders 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 supplemented by disorientation in time and space - the patient has difficulty determining the date, location. Headache appears once at the moment of injury, then weakens and increases withnew intensity in the third phase.
Meningeal manifestations of pathology include signs indicating damage to the meninges. Among them are:
- headache;
- vomiting that is not food related;
- positive meningeal signs.
Such symptoms are often observed in other disorders. If cerebral signs are absent or mild, the diagnosis of subdural cerebral hemorrhage is not confirmed.
Focal symptoms are represented by unilateral pupil dilation, with a sharp decrease in its reaction to light. Sometimes doctors fix stupor in the victim - severe depression of consciousness. In especially serious cases, coma sets in.
Features of pathology in children
Subdural hemorrhage in newborns is quite common. It is a consequence of intracranial birth trauma and accounts for approximately 40% of the number of intranatal pathologies. Among its main reasons, doctors note the following:
- large fruit;
- use of intracavitary obstetric forceps;
- fast and rapid delivery;
- foot/breech presentation.
It is very easy to suspect he alth problems in a child. All unconditioned reflexes of the baby are in a depressed state. He is not able to take the breast, swallow. Squeezing of the brain stem by a hematoma provokes dilation of the pupils, convulsions. These symptoms appear in the first three days after childbirth.
Diagnostic Methods
After any traumatic brain injury, you must seek qualified help. Do not risk your he alth and ignore the initial signs of hemorrhage. Diagnosis of 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 localization of a hematoma can be obtained after a computed tomography. MRI is considered to be no less informative. If a traumatic subdural hemorrhage is suspected, it is strictly forbidden to perform 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, its treatment must be started immediately. Only in this case can we hope for a favorable forecast.
Surgical and conservative methods of therapy are used to eliminate the violation. The latter option is used in the case of a small hematoma, the absence of obvious progression. Patients are prescribed drugs with decongestant action, medicines to improve blood circulation and brain metabolism. It also shows the intake of vitamins and analgesics. This treatment is recommendedelderly patients diagnosed with subdural hemorrhage, acute, non-traumatic.
Most cases of pathology are subject to surgical intervention. During the operation, an opening of the skull (trepanation) is performed, followed by removal of the spilled blood. The final step is to rinse the cavity with saline, restore the integrity of the cranium and install a special drain.
As for little patients, they are trying to be treated with medication. The lack of positive dynamics is the reason for the operation.
Consequences and prognosis for recovery
The occurrence of a hemorrhage is accompanied by a displacement of the brain and infringement of its stem structures. The development of pathology usually occurs against 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 the visit 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 volume of the hematoma.
Complicated subdural hemorrhage has not the most favorable consequences. Usually, patients with this diagnosis become disabled or die altogether.
