Subdural hematoma is an intracranial accumulation of blood between the meninges (arachnoid and dura). Most often, it occurs after trauma and manifests itself in the form of disorders of the psyche and consciousness.. In men, this pathology occurs three times more often than in women.. In most cases, it occurs in people over forty years of age..

Subdural hematoma occurs as a result of a traumatic brain injury Almost 22% of severe TBIs (traumatic brain injuries) are accompanied by the appearance of a subdural hematoma. Unlike the epidural, the subdural form of hemorrhage can form not only on the injured area of \u200b\u200bthe head, but also on the opposite side..

Causes The cause of the appearance of a subdural hematoma of the brain can be:.

rupture of pial or cortical vessels that pass in the subdural space, resulting from a traumatic brain injury. In this case, the head should be inactive, and the object that is struck should be small in area.;

reversing or stopping abruptly when falling on your legs or buttocks. In this case, a sharp shaking of the head leads to a displacement of the brain inside the skull, as a result of which the intracranial veins are torn.;

hitting the head on a massive inactive object. Hemorrhage is the result of rupture of the veins flowing into the sagittal venous sinus. The most common cause of this type of injury is a fall from a great height or on your back, a collision of motorcycles or cars.;

impact on the motionless head of an object with a volumetric contact area. Often, injuries of this type occur when heavy objects, logs, snow blocks, sides of cars fall on the head.. In this case, there is also a rupture of the bridge veins flowing into the superior sagittal sinus.;

vascular-cerebral pathologies caused by systemic vasculitis, arterial hypertension or aneurysm of cerebral vessels;

bleeding disorders due to coagulopathy or uncontrolled intake of anticoagulants.

The shape and severity of the hemorrhage depends on many factors, including the direction of the blow. If several mechanisms of injury occur simultaneously, the patient develops bilateral subdural hematomas.

ClassificationDepending on the causes of subdural hematoma, determine:.

non-traumatic hemorrhage;

traumatic hemorrhage (with or without a penetrating wound).

Subdural hematomas are also classified as follows:.

The form.

Description.

Acute subdural hematoma.

Occurs within the first three days after TBI.

Subacute subdural hematoma.

It takes from 3 to 14 days from the moment of TBI.

Chronic subdural hematoma.

Occurs later than two weeks after injury, while it is limited to a capsule formed due to the activation of fibroblasts of the dura mater of the brain.

To form an acute subdural form, a traumatic brain injury must be severe.. For the appearance of an acute and subacute form, a slight injury is sufficient.

A lamellar subdural hematoma is a hemorrhage of a small volume (up to 50 ml), which, during a CT scan, does not displace the ventricular system of the brain..

Depending on the mechanism of formation of hemorrhages, they are classified as follows:.

homolateral: in this case, the area of \u200b\u200bthe traumatic agent is small, and it is applied to a motionless or inactive head;

contralateral: occur when the moving head hits an immovable or massive object or as a result of injury to the agent with a wide object of an immovable head.

Symptoms With subdural hematoma, the patient has local, cerebral and secondary stem symptoms. This is due to compression of the brain and increased intracranial pressure.. Particular attention is paid to the "

In severe TBI, it can be a few minutes, while in subacute or chronic form, it stretches for several weeks or even months..

In some cases, the appearance of signs of pathology causes additional trauma or a sharp jump in blood pressure.. Most often, the change in the state of consciousness occurs gradually.. In rare cases, the patient suddenly falls into a coma (as in an epidural hemorrhage).

The most important role among the focal signs of injury is played by unilateral pupil dilation, in which its reaction to light decreases:.

acute form of the disease: the pupil is maximally dilated and practically does not react to light;

subacute and chronic form of the disease: moderate mydriasis occurs (while the reaction of the pupil to light is preserved).

Headache is one of the symptoms of pathology. Another constant symptom of subdural hematoma is a bursting headache.. It accompanies the patient almost constantly, gives to the eye area or the back of the head and intensifies with the movement of the eyeballs.. Cephalgia is aggravated by tapping on the skull and may be accompanied by nausea, vomiting, photophobia.

The patient often has disintegration of consciousness in the form of the following manifestations:.

mental disorders occurring with impaired attention, thinking, clouding of consciousness;

confusion, incoherence of speech and thinking, randomness of movements;

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conduct disorder;

state of euphoria.

Patients with hematoma often experience psychomotor agitation.. In some cases, there may be epileptic seizures.

Pathology may be accompanied by a change in muscle tone, a person begins to move too slowly, while the grasping reflex is disturbed..

Classic variant This variant of subdural hematoma is quite rare.. It is characterized by the following clinical picture:.

short-term loss of consciousness at the time of traumatic brain injury;

the duration of the light interval is from 10 minutes to 2 days.

Patient has headache, dizziness and nausea. At the next stage, drowsiness appears, the headache increases sharply, the person becomes inadequate. Clearly manifested homolateral mydriasis. Along with loss of consciousness, the rhythm of breathing changes, blood pressure rises, and tonic convulsions occur..

Subdural hematoma with or without obliterated “light” space This variant is typical of severe brain contusions. Initial loss of consciousness can easily develop into a coma. In the future, it is possible to restore consciousness, while psychomotor agitation is noted, headache and nausea occur.. After some time, the patient loses consciousness again.

Quite often there is a variant without a " After a serious traumatic brain injury, a person falls into a coma, and in the future, until the moment of surgery or his death, no positive dynamics is observed..

Diagnosis and treatmentIn order to diagnose pathology after severe traumatic brain injury, such studies are carried out as: x-ray of the skull, Echo-EG, ophthalmoscopy, CT or MRI of the brain.

The diagnosis is confirmed by computed tomography. Drug therapy. Conservative treatment is carried out in the following cases:.

the victim is in clear consciousness, has a hematoma less than 1 cm thick, with a displacement of cerebral structures up to 3 mm;

no signs of brain compression;

intracranial pressure does not exceed 25 mm Hg. st.

stable neurological status.

In complex therapy, antifibrinolytic drugs are used (Vikasol, Aminocaproic acid). Other drugs, depending on the goals of treatment:.

vasospasm prophylaxis: Nimodipine or Nifedipine;

elimination of cerebral edema: Mannitol or Mannitol;

relief of symptoms: antiemetic, anti-inflammatory, analgesic and sedative drugs.

With proper and timely treatment, resorption of the bruise occurs within a month..

The patient is shown bed rest and long-term use of drugs that accelerate the resorption of hemorrhage. Traditional medicine methods for such injuries do not have the necessary effect.. This approach to treatment contributes to the deterioration of the patient's health and the chronicity of the process..

Surgical intervention In acute and subacute subdural hematomas that cause compression and displacement of the brain, immediate surgical intervention is indicated.. The sooner the hemorrhage is eliminated, the greater the patient's chances of recovery..

The need for surgical intervention is determined by the doctor after diagnostic studies. Also, the operation is indicated in the subacute form, if the patient has signs of intracranial hypertension or focal symptoms increase..

The operation can also be performed for chronic hematoma: surgery may be needed if the patient's condition worsens, stagnation occurs in the fundus and headaches increase. In this case, closed external drainage is performed..

Prognosis With this type of injury, death occurs in 50–60% of cases.. Elderly patients are more likely to die. The most favorable prognosis for patients who underwent surgery during the first six hours after a traumatic brain injury.

Mild forms of hemorrhages are amenable to conservative treatment and resolve within a month.. In some cases, there is a transformation into a chronic form.

It should be noted that hemorrhage itself is not the cause of death.. In most cases, death occurs as a result of brain tissue damage, edema, or secondary cerebral ischemia..

The threat of death persists even after removal of the hemorrhage by surgical intervention, since an increase in cerebral edema is possible in the postoperative period.

When practicing traumatic sports, it is important to wear protective equipment. In order to avoid the occurrence of injuries and hemorrhages, it is necessary to follow safety rules.. When riding motorcycles, rollerblading, participating in extreme sports or being on construction sites, you must use a protective helmet.

The consequences of TBI are dealt with by such specialists as a neurosurgeon, traumatologist and neurologist. For any traumatic brain injury, you should seek the advice of a doctor.

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