Intracranial hematoma.

Intracranial hematomas most often develop when the inner plate of the compact substance of the cranial bones (glass plate - laminavitria) is damaged without damage to the outer plate of the compact substance. Such a fracture is not diagnosed either clinically or by plain radiography. The source of bleeding is the spongy substance of the damaged bone or a branch of the meningeal artery (usually a. meningia media), which is damaged by a bone fragment through the dura mater. Accordingly, epidural and subdural hematomas are formed, localized mostly in the temporo-parietal regions. The main clinical manifestation of these hematomas, which determines their danger to life, is the brain compression syndrome. Victims with intracranial hematomas require emergency surgical treatment.

In the event that the bleeding stops quickly and there is no compression of the brain, they speak of a subarachnoid hemorrhage. This condition, although it needs serious treatment, is not life threatening.

In addition, with particularly severe injuries, bruises of the brain stem, intracerebral and intraventricular hematomas can form. With these hematomas, the stem syndrome clinic dominates from the very beginning, there is no phasic flow typical for epi- and subdural hematomas.

The main danger of the clinic of epi- and subdural hematomas is that after receiving a TBI, a period of “imaginary improvement” or “light interval” begins, which can last from several hours to 10 days. In rare cases, hematomas can develop in more late dates- up to 30-40 days after the injury. Such hematomas are caused by a secondary displacement of fragments of the "glass" plate after activation of the victim or recurrent bleeding from the damaged vessel during blood pressure drops or thrombus lysis. In most cases, the "light interval" does not exceed 1 day.

The clinic of the actual hematoma, that is, compression of the brain, begins with an increase in headache, usually of a bursting nature, aggravated by lowering the head down, increased nausea, increased vomiting, and increased dizziness. During this period, victims often experience unconscious anxiety, are excited, talkative, and cannot find a comfortable position for themselves. The earliest reliable symptoms of developing intracranial hematoma are decrease in heart rate and dilation of the pupil from the side of the hematoma. These symptoms are due to the hematoma pushing back the temporal lobe and the tension of the vagus and oculomotor nerves. Sometimes there is also a decrease in NPV.

Further, the condition of the victims progressively worsens. Excitation is replaced by lethargy, gradually turning into stupor and coma. Bradycardia increases, breathing becomes frequent and noisy (coma), spastic hemiparesis appears with a predominant lesion of the arm from the side opposite to the hematoma. Other focal symptoms may also be observed: smoothness of the nasolabial fold, deviation of the tongue. Meningeal symptoms may appear.

The temporal lobe continues to move posteriorly with a growing hematoma. Its posterior pole is wedged into the foramen magnum, infringing on the medulla oblongata. Death is coming.

The only way to save the life of a victim with an intracranial hematoma is an emergency surgical intervention - decompression craniotomy, and the prognosis is better, the earlier the operation is undertaken. After the increasing compression leads to the development of edema-swelling of the brain, even decompressive trepanation cannot always prevent a further increase in intracranial pressure and progression of the herniation syndrome.

First aid at the prehospital stage with the development of intracranial hematoma is similar to that for other forms of TBI. Special attention should be given to the control of vital functions, the violation of which can develop very quickly.

An intracranial hematoma is an accumulation of blood and is fraught with very serious consequences, since filling the cranial cavity with fluid almost always leads to compression of the brain.

In a child, traumatic hematomas are most often found, while in adults they often occur due to:

• tumors;
• aneurysm rupture;
• some infections;
• strokes.

The main problem of this pathology is the absence of any signs of a clinical nature in the early stages of formation. Symptoms usually appear after a while.

It is worth noting that an intracranial hematoma is dangerous because it presses directly on the brain. As a result, edema and irreversible damage to its tissues are often formed. If left untreated, there is a high chance of death.

Varieties

There are several types of intracranial hematomas:

• acute makes itself felt the fastest - no later than 3 days;
• subacute manifests itself longer - within 3 weeks;
• chronic can go unnoticed for up to a month.

They are also distinguished by size:

• hematomas up to 50 milliliters are considered small;
• medium - up to 100;
• large - over 100.

Causes

An intracranial hematoma can form due to:

• trauma;
• diseases.

In particular, the subdural type of hemorrhage is manifested due to damage to the vessels connecting the brain directly to the venous system and the sinuses of its hard shell. In this situation, the accumulation of blood is rather slow and therefore tissue compression does not begin immediately. As a result, symptoms are usually noticed after 1-2 weeks.

An epidural type of hematoma occurs due to a rupture of one of the vessels passing between the skull and the hard shell. Because the pressure in the arteries is greater than that in the veins, the accumulation of blood is much faster. The first symptoms often make themselves felt within 2-3 hours after the start of the formation process.

Intracerebral hematomas are the most dangerous, as they form directly in internal tissues. If a we are talking about the traumatic nature of the hemorrhage, then damage to the white matter mainly occurs.

The consequences of this situation come very quickly. Due to the rupture of neurites, impulses to internal organs and parts of the body do not pass - accordingly, they cease to function properly.

Intracerebral is also often the result of hemorrhagic stroke. Here, due to the rupture of a thinned vessel, blood flows under great pressure into the brain tissue and quickly fills all the free cavities there.

Symptoms

Early diagnosis is significantly difficult, because, as previously noted, the signs of the appearance of a hematoma do not appear immediately. It usually takes some time before the patient begins to feel worse.

The severity and nature of symptoms is influenced by:

• severity of damage;
• the size;

Since in most cases a hematoma appears as a result of a traumatic effect, its signs correspond to those that accompany damage to the brain tissue.

The epidural form manifests itself most quickly. The patient has:

• strongest acute headache;
• drowsiness;
• loss of clarity of consciousness;
• dilation of the pupil from the side of the hemorrhage;
• epileptic seizures;
• paresis (acutely progressive).

Often patients fall into a coma. If the size of the hematoma reaches 150 milliliters, then death occurs.

The child usually has the following symptoms:

• there is no primary loss of consciousness;
• the development of edema occurs at lightning speed.

The victim needs emergency surgery.

subdural hematoma long time does not show itself in any way, since the defeat at first remains insignificant. In infants, after some time, the head may increase. Elderly people face the subacute form most often. Young people usually complain of headaches. Sometimes it is accompanied by vomiting and nausea. In severe cases, seizures and epileptic seizures.

Small hematomas resolve over time, while large ones must be removed surgically.

Symptoms of intracerebral hematomas that appear after a stroke vary depending on which part of the organ was damaged. However, in all situations, patients complain of migraine (moreover, only half of the head hurts). They also see:

• heavy breathing with wheezing;
• fainting;
• convulsions;
• paralysis;
• vomiting.

If the brain stem is damaged, then the person is guaranteed to die.

Acute extensive traumatic hematomas have a number of very obvious signs:

• headaches;
• loss of consciousness;
• nausea;
• signs of epilepsy;
• severe convulsions.

Hematoma localization is possible only during the operation.

An aneurysm rupture is indicated by the strongest sudden sharp pain like being stabbed with a knife.

Treatment

The only one for real effective tool from an intracranial hematoma, the operation remains today. There are several methods, which one to use - the surgeon decides, taking into account the type of damage, the patient's condition and his age.

At the end of the procedure, the doctor prescribes a number of drugs that can alleviate the often occurring post-traumatic convulsions. The latter can appear in operated patients after a few months, and even a year later.

Sometimes patients in recovery period complain about:

• amnesia;
• attention disorder;
• headaches.

Rehabilitation activities for adults are very lengthy - it often takes one or two years to recover.

An intracranial hematoma is a collection of blood inside the skull that puts pressure on the brain, obstructing normal circulation, and cutting off oxygen to the brain. Among the consequences of this condition are amnesia, decreased intelligence, anxiety, impaired attention, post-traumatic convulsions. If this disease is not treated in a timely manner, there is a risk of developing cerebral edema with damage to the brain tissue and its subsequent destruction. Symptoms of intracranial accumulations of blood often do not appear immediately, but some time after the formation of a pathological condition.

And because of this, the possibility of timely detection of pathology is complicated, which sometimes leads to the occurrence of irreversible processes in the brain. Depending on the time of manifestation of clinical symptoms, there are:

1. Acute, manifesting itself within 3 days from the moment of formation.
2. Subacute, manifested for 3 weeks.
3. Chronic, manifested after 3 weeks or more from the moment of occurrence.

Intracranial accumulations of blood of average size have a volume of 50-100 ml, of course, their size can be smaller or larger. Small collections of blood can sometimes dissolve on their own; a hematoma larger than 150 ml leads to lethal outcome.

Classification of hematomas and clinical manifestations

Symptoms depend on the location of the hematoma, its size, and the age of the patient. Hematomas are classified as follows:

1. Epidural - located above the hard shell of the brain. Occur when an artery or vessel between the skull and outer surface hard shell of the brain. Since there is high pressure in the arteries and vessels, when they break, blood flows out quickly, so this type of hematoma has acute manifestations. Possible symptoms, usually manifested within a few days, and sometimes hours: severe headache, drowsiness, confusion, epileptic seizures, paralysis, progressive pupil dilation on the side of the hematoma, progressive paresis, coma. In children, this swelling develops very quickly.
2. Subdural - located between the hard shell and the medulla. They are formed in the process of rupture of the veins connecting the sinuses of the hard shell and the venous system of the brain. The blood pressure in the veins is less than in the arteries, so the blood flows out slowly, and the hematoma may not make itself known for 2-3 weeks. vary depending on the age of the person. For example, in young children, the head may increase; in persons under 35 years of age, the appearance of a hematoma is expressed in headaches, vomiting and nausea, epileptic seizures, convulsions, sometimes the pupil expands from the side of the edema.
3. Intracerebral, intraventricular hematomas are located inside the main brain or ventricles of the brain. Clinical manifestations: headache (often on one side), hoarse breathing, loss of consciousness, vomiting. When a brain hemorrhage occurs as a result of an injury, the white matter and the neurites in it, or axons - long processes nerve cells through which nerve impulses travel from neurons to other cells or organs. This is the reason why such a hematoma can cause paralysis and convulsions.
4. Brain stem hematomas are fatal.
5. Diapedetic - occur due to vascular hemorrhage (hemorrhagic impregnation) due to their increased permeability. With such a lesion, the patient experiences a severe sharp headache.

Reasons for the formation of intracranial hematomas

Intracranial hematomas occur for the following reasons:

1. Traumatic brain injury is the most common cause of hematoma.
2. circulatory diseases, vascular system, oncological diseases, infections, strokes can contribute to the thinning and rupture of blood vessels.

Methods for the diagnosis and treatment of intracranial hematomas

You can reliably diagnose intracranial hematoma using:

1. CT - computed tomography, a technology that allows you to study the layers of the brain. For this, X-rays are used.
2. MRI - magnetic resonance imaging, a layered study of the brain based on nuclear magnetic resonance.

After the diagnosis is made, necessary treatment. Conservative therapy consists in the appointment of drugs that reduce intracranial pressure and promote resorption of the hematoma. Along with the appointment of medications, bed rest is prescribed, however, this technique helps only in some cases, most often it is necessary surgical removal hematomas.

Surgery and recovery after

The procedure for removing an intracranial hematoma is performed under general anesthesia. There are several methods for performing the operation:

1. Osteoplastic trepanation. AT cranium produce a small hole. Then the accumulations of blood are removed using a special vacuum, in the presence of dense blood clots, tweezers are used. The damaged area is washed with a solution of sodium chloride and a hemostatic gauze or sponge is placed in this area to stop bleeding.
2. Stereotactic removal. This procedure is performed for strokes, as it is more gentle, but that is why the risk of relapse is higher. A small hole is drilled in the skull, through which a special tube (cannula) is inserted into the hematoma cavity, which takes blood from the affected area by aspiration (absorption due to low pressure). A special navigation system is used to monitor the process.
3. Puncture-aspiration removal - puncture of the hematoma with a needle and the introduction of a special catheter (cannula), with which blood is extracted in the amount of ½ or 1/3 of the volume of the entire hematoma. The tube remains inside and is held for several days repeated procedure. Sometimes injected into the hemorrhage cavity medications designed to dissolve clots to facilitate aspiration.

After the procedure, the patient is scheduled to receive anticonvulsants if the cause of the hematoma was trauma.

It is also necessary to control the level of intracranial pressure, which increases the development of cerebral edema, which can persist for 14 days after surgery.

The patient who has undergone complex operation, must be under the strict supervision of a physician and comply with all his prescriptions.

The postoperative recovery period is at least 6 months, but ultimately it all depends on individual features the body of the patient and his age (the younger the person, the faster and easier the recovery).

Complications after surgery to remove a hematoma and contraindications to its implementation

Possible complications after surgery to remove an intracranial hematoma:

• headaches;
• attention disorder;
• amnesia;
• convulsions;
• swelling of the brain;
• recurrent bleeding.

Surgical therapy is contraindicated if the patient is in a severe coma, that is, when it is clear that the patient will not survive the operation.

In addition, the procedure is not performed if the hematoma does not threaten a person’s life and does not cause serious neurological disorders. In such cases, surgery, on the contrary, may worsen the condition due to subsequent complications.

Intracranial hematoma (blood tumor) is an accumulation of blood in the cranial cavity, which reduces the intracranial space and contributes to brain compression. Similar accumulations of blood occur as a result of aneurysm rupture, vascular injuries and hemorrhages - into the tumor, infectious origin or as a result of a stroke.

A feature of intracranial hematoma is that clinical manifestations do not occur immediately, but after a certain period of time.

The most main danger intracranial hematoma is that it exerts significant pressure on the brain. As a result, cerebral edema may form with damage to the brain tissue and its subsequent destruction.

Hematomas are:

• acute - symptoms appear within 3 days from the moment of formation;
• subacute - symptoms appear for 21 days;
• chronic - the manifestation of symptoms occurs after 21 days from the moment of formation.

By size, small hematomas (up to 50 ml), medium (50-100 ml) and large (more than 100 ml) are distinguished.

According to the location of the hematoma, they are divided into:

• epidural, located above the hard shell of the brain;
• subdural, with localization between the substance of the brain and its hard shell;
• intracerebral and intraventricular, the place of localization of which falls directly on the substance of the brain;
• intracranial hematomas of the brain stem;
• diapedetic hematomas resulting from hemorrhagic impregnation, while the integrity of the vessels is not violated.

The main causes of intracranial hematoma

The main cause of intracranial hematoma is disease or injury.

So, subdural hemorrhage often occurs as a result of rupture of the veins connecting the brain and the venous system, as well as the sinuses of the dura mater. As a result, a hematoma is formed, which compresses the brain tissue. Since blood from a vein accumulates slowly, the symptoms of a subdural hematoma may not appear for several weeks.

An epidural hematoma usually results from a rupture of an artery or vessel between the skull and the outer surface of the dura mater. Arteries have higher blood pressure than veins, so blood flows out of them faster. An epidural hematoma rapidly increases in size and increases pressure on the brain tissue. Symptoms usually appear fairly quickly, sometimes even within a few hours.

An intracerebral hematoma is formed as a result of penetration of blood into the brain. If a cerebral hemorrhage occurs as a result of an injury, then the white matter of the brain is predominantly affected. As a result of such damage, neurites rupture, which stop transmitting impulses to different parts of the body. An intracerebral hematoma can also form as a result of a hemorrhagic stroke. In this case, the hemorrhage occurs from an unevenly thinned artery wall and the blood under high pressure enters the brain tissue and fills the free space. Such a hematoma can form anywhere in the brain.

Thinning and ruptures of blood vessels occur, as a rule, as a result of tumors, infections, angioedema, atherosclerotic lesions, etc.

Sometimes diapedetic hemorrhages may occur, which occur as a result of increased vascular permeability (when the coagulation properties of the blood or tissue hypoxia change). This leads to the formation of accumulations of blood around the damaged vessels, which often come together and form an intracranial hematoma.

Symptoms of an intracranial hematoma

Often the symptoms of intracranial hematoma appear after a certain period of time. The main symptoms depend on the nature of the intracranial hematoma and its size. Since the hematoma mainly develops as a result of traumatic injury, then the symptoms generally predominate, characteristic of brain damage. In addition, the symptoms of hematoma may differ depending on the age of the patient.

With an epidural hematoma, symptoms appear quickly. Patients suffer from severe headache, drowsiness, confusion. Often, patients with epidural hematoma lapse into coma. With the formation of a hematoma with a volume of more than 150 ml, a person dies. Progressive dilation of the pupil on the side of the hematoma is noted. The patient may experience epileptic seizures, paralysis and progressive paresis. In children, the symptoms of epidural hematoma are next character: there is no primary loss of consciousness, edema develops very quickly and requires immediate surgical treatment intracranial hematoma.

With the formation of a subdural hematoma, symptoms usually do not appear immediately, and the initial lesion seems insignificant. Symptoms usually begin to appear after a few weeks. In young children, there may be an increase in the head in size. In elderly patients, a subacute course of hematoma is observed. Young patients feel a headache, later vomiting and nausea, epileptic seizures and convulsions may appear. Pupil dilatation on the side of the injury may be noted, but not always. Small intracranial hematomas may resolve on their own, while large hematomas need to be emptied.

With an intracerebral hematoma as a result of a hemorrhagic stroke, the symptoms depend on the lesion. Most frequent symptoms are headache (mainly on one side), hoarse breathing, loss of consciousness, as well as paralysis, convulsions and vomiting. With damage to the brain stem, treatment of intracranial hematoma is impossible, and the patient dies.

With intracranial hematoma, which was formed as a result of extensive trauma, the symptoms, as a rule, are: headache, loss of consciousness, vomiting, nausea, epileptic seizures, convulsions. To determine the localization of such a hematoma is usually possible only as a result of surgery.

With the formation of a hematoma due to rupture of the aneurysm, the main symptom is acute and sharp pain in the head (like a dagger stab).

Treatment of intracranial hematoma

The main treatment for intracranial hematoma involves surgical intervention. The type of operation often depends on the nature of the hematoma.

After the operation, the doctor prescribes anticonvulsants. medicines for the prevention or control of post-traumatic seizures. It happens that such convulsions begin in a patient even a year after the injury. For some time, the patient may experience amnesia, headache and impaired attention.

The recovery period after an intracranial hematoma is usually very long. In adult patients, the recovery period takes at least six months. Children tend to recover much faster.

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