The brain consists of several membranes. The strongest 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 membrane and the brain. In this case, the victim is diagnosed with a "subdural hemorrhage". It is about this pathology that will be discussed in today's article.
Mechanism of damage formation
The appearance of subdural hemorrhage is usually preceded by trauma. At the site of bleeding, a hematoma forms, which is rapidly expanding. It carries a potential threat of damage to brain tissue that is sensitive to this kind of effects. The consequence of these processes is the appearance 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 in the event that the previous hemorrhage did not have time to resolve. The hematoma is covered by its own membrane, into which blood vessels can germinate. Against the background of an unstable state, these elements often burst, which contributes to the repeated growth of damage. The doctors recorded numerous cases of the formation of giant hematomas, formed by this type.
Specifying the above facts can be argued that subdural hemorrhage in the brain develops as a result of damage to cortical and crazy vessels. In rare cases, pathology is preceded by a disruption in the work of the Galen vein 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 (impact on the "torpedo" or instrument panel). The risk group includes front seat passengers who do not use seat belts.
- Falling on the head of icicles and blocks of ice in the winter season.
- Sports injuries.
- Head injuries in the workplace due to non-compliance with safety regulations.
- Household fights.
The listed reasons are classified as traumatic. It is important to understand that the hematoma develops gradually in these cases. The larger the damaged vessel, the more intense the hemorrhage and the more rapid the characteristic clinical picture.
Significantly, the disorder occurs against the background of vascular pathologies of the brain. These include hypertensive disease and arterial aneurysm. In some cases, the emergence of a hematoma is due to the use of anticoagulants. These factors cause a subdural hemorrhage nontraumatic.
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:
Let's consider what each of the options represents:
- Acute subdural hemorrhage develops within 1-2 days from the time of injury. The main cause of the appearance of a hematoma is a severe and severe effect on the brain.
- In a subacute form, from the time of the injury to the appearance of the first symptoms can pass from 4 days to several weeks. Traumatic impact is not so strong. The caliber of the affected vessel is not large, so 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 mechanism for the development of hematoma, then in this case it plays a secondary role. Most often the chronic form of hemorrhage is a consequence of cerebrovascular diseases.
The specific form of the disorder determines the primary symptomatology.
Subdural hemorrhage is characterized by the fact that the symptoms manifest themselves with an exact alternation of several phases.
Immediately after a traumatic impact, a person loses consciousness. This disorder is caused by the body's response to acute and sudden pain, a stress factor. Then the patient comes to his senses and starts complaining of weakness and deafness. In some cases, the clinical picture is supplemented with retrograde amnesia - a brief loss of memory for events preceding the trauma.
The second phase is characterized by improvement of well-being. Not every person, after receiving damage, is attentive to the state of health in order to visit a doctor. This disregard for one's own health can lead to more serious injuries. It is about those situations when the victim sits 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 category of cerebral palsy includes such violations, which can be observed in any other disorders. However, their appearance indicates a serious enough damage to the brain. First of all, the victims have a severe headache. A person can become apathetic and indifferent to everything that is happening. The clinical picture is often supplemented by disorientation in time and space - the patient has difficulty in determining the date, location. The headache appears once during the moment of injury, then weakens and grows with a new intensity in the third phase.
To the meningeal manifestations of the pathology include signs indicating damage to the meninges. Among them are:
- Vomiting, which is not due to food intake;
- Positive meningeal signs.
Such symptoms are often observed in other disorders. If cerebral symptoms are absent or weakly expressed, the diagnosis "subdural cerebral hemorrhage" is not confirmed.
Focal symptoms are represented by a one-sided dilatation of the pupil, while its reaction to light is sharply reduced. Sometimes the injured physician fixes a sopor - heavy oppression of consciousness. In especially serious cases coma sets in.
Features of pathology in children
Subdural hemorrhage in newborns is often enough. It is a consequence of intracranial birth injuries and accounts for approximately 40% of the number of intrapartum pathologies. Among the main reasons for it doctors note the following:
- A large fruit ;
- Use of intracavitary obstetric forceps;
- Fast and rapid delivery;
- Leg / breech presentation.
It is very easy to suspect a child's health problems. All unconditioned reflexes of the baby are in a depressed state. He is not able to take breasts, swallow. Squeezing the hematoma of the brainstem provokes the dilatation of the pupils, convulsions. The listed symptoms are manifested in the first three days after childbirth.
Methods of diagnosis
After any craniocerebral trauma you need to seek qualified help. Do not risk your health and ignore the initial signs of hemorrhage. Diagnosis of pathology is based on the collection of anamnesis and patient's questioning. It is important for the doctor to know all the information about the nature of the injury, the order of the appearance of clinical symptoms.
The most complete information on the localization of the hematoma can be obtained after a CT scan. No less informative is MRI. If suspected of traumatic subdural hemorrhage, it is strictly forbidden to perform lumbar puncture. This procedure implies the intake of cerebrospinal fluid by means of a special needle. Its consequences can be irreversible.
After confirming the diagnosis, the patient is immediately hospitalized. Subdural hemorrhage is a serious pathology. Therefore, its treatment should be started immediately. Only in this case it is possible to 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 hematoma sizes, the absence of obvious progression. Patients are prescribed drugs with anti-edematous action, medications to improve blood circulation and brain metabolism. Also shown the intake of vitamins and analgesics. Such treatment is recommended for elderly patients diagnosed with subdural hemorrhage acute, non-traumatic.
Most cases of pathology are subject to surgery. During the operation, the skull is opened (trepanation) followed by the removal of the bleeding. The final stage is washing the cavity with saline, restoring the integrity of the skull and installing a special drainage.
As for small patients, they are trying to treat medication. The lack of positive dynamics is the reason for the operation.
Consequences and prognosis for recovery
The appearance of hemorrhage is accompanied by a displacement of the brain and infringement of its stem structures. The development of pathology usually occurs against a background of severe damage to the skull, so the forecast in most cases is unfavorable. However, the end result depends on the time of treatment to the doctor and the correctness of the selected treatment. If the victim was able to operate within 6 hours after the injury, recovery occurs in 80% of cases. In addition, the forecast is influenced by the age of the patient, the presence of somatic disorders and the volume of hematoma.
Complicated subdural hemorrhage consequences are not the most favorable. Usually patients with such a diagnosis become disabled or completely die.