What is epidural hematoma of the brain and what are its health effects?
Epidural hematoma is 1% of the total number of brain injuries resulting from accidents in the home, sport and road accidents.
Hematoma in the region of localization are divided into:
- Intracerebral. Are directly in the brain tissue.
- Subdural. Disposed under the hard shell of the brain.
- Epidural. Located between solid outer brain shell and the bones of the skull.
Symptoms of acute hematomas occur in the first three days until the capsule is formed. Subacute manifests itself between the fourth day to two weeks, when it formed a capsule of hematoma. Two weeks and more can manifest the chronic form. Typically, epidural hemorrhage diagnosed in the acute stage. Subacute and chronic rarely occur. Mostly in elderly patients with trophic changes in the brain. In young children the Dura mater tightly fixed to the inner surface of the skull, so they have this kind of hemorrhage is practically not observed.
The size of the hematoma are divided into small (bleeding up to 50 ml), medium (to 100 ml) and large (more than 100 ml). They are single, multiple, single, two way and when the injury can be combined. Thus, in trauma the hematoma can be located in the impact area, and from the opposite side. Hematoma is impregnated with blood, brain tissue, and the affected area begins to lose its functions.
The cause of a hematoma is quite simple: liquid or clotted blood collects between the Dura and the bones of the skull. If the injury damaged the middle meningeal artery or its branches and is torn venous sinus. Dura peeled from the bone, forming a cavity begins to fill with blood. If the bleeding is not stopped in time, detachment of the shell continues and further increases the size of the hemorrhage.
The Peculiarity of epidural hematomas: it is shaped similar to a biconvex lens (thick Central portion that tapers to the edges) with clear contours. According to the structure in the acute period it has homogeneous consistency, sometimes mixed with clots. The volume can reach up to 250 ml. with a Diameter up to 8 cm.
On the second day, the hematoma turns into a clot. A week later it condenses, and becomes inelastic. Two weeks later the clot becomes brown and begins to crumble into small pieces. And only three weeks later, is formed connective tissue capsule.
Types of bleeding are:
- When arterial bleeding bleeding increases rapidly, reaches a large thickness. Deformation of the cortex significant increased intracranial pressure.
- If the damage of the veins and venous sinuses hematoma grows slowly. The pressure on the fabric and minor symptoms may be subtly expressed.
In 60-70% of cases of traumatic impact accounts for the parietal or temporal region. Frontal and occipital localization of the hemorrhage is quite rare.
the Concept of light period
The Symptoms of epidural hemorrhage may develop from the injury a few days. Time and the severity of the symptoms depends on the localization and the amount of extravasated blood.
Immediately after the injury the victim loses consciousness. It then recovered, and the victim worried about the headache, dizziness and nausea. This so-called lucid interval.
After that, epidural hematoma starts to progress: on the affected side is the pupil and the eyelid is lowered. On the opposite side increased tendon reflexes and muscle weakness. The severity of the disease increases: the victim is agitated, he has a severe headache and starts vomiting. In severe cases, loss of consciousness goes into a coma. Joins the respiratory rhythm, the pulse becomes rare and increases blood pressure.
Subacute different a longer "bright period". It could take up to two weeks. Signs of smoother functions are slightly changed.
clinical management of patient
Treatment of hematomas is conservative and operative.
Conservative treatment is used in case of small hematomas (up to 2 cm) and when there are no signs of compression of brain tissue. Assigned hemostatic agents (implantation), diuretics. Carry out correction of blood pressure and prevention of pulmonary embolism. As a rule, the hemorrhage is resorbed and does not harm the victim's health.
Surgery is performed in patients with medium and large hemorrhages and signs of compression of the brain tissue. It's urgent (urgent) surgery. Urgent operative removal is transcranial (withthe trepanation of the skull bones). The cavity is opened, the hematoma is removed, the audit wounds and koaguliruet the bleeding vessel. At the end of surgery is drainage. Remove the hematoma and endoscopic method. These operations are less traumatic, but not always appropriate. A small hole does not allow to carry out a full review of the wound and to remove all clots.
Favorable prognosis largely depends on the timing of surgical interventions. The earlier the operation, the higher positive results of treatment. In the postoperative period the patient is prescribed antibiotic therapy and medication to restore the brain tissue.
Further treatment is prevention of hypotension and normalization of intracranial pressure.
Only when timely and competent care of the victim recovering the broken functions without any consequences. Otherwise, he may lose the ability to work and remain disabled.