Hematoma of the brain is most often the result of a head injury, in most cases - a blow and a traffic accident. In old age, even a minor traumatic impact can lead to rupture of blood vessels and the formation of a hematoma..

Most often, cerebral hemorrhage occurs as a result of trauma. The human brain (hereinafter - GM) is represented by neurons (parts of which form the gray and white matter of the brain) and its three membranes - hard, soft and arachnoid. Each of them performs vital functions.

The structure of the brain Hard shell - its most superficial, outer part, facing the inner surface of the bones of the skull, and the inner - to the arachnoid. It is rich in nerve endings and forms cavernous sinuses and sheaths for nerves exiting the cranial cavity..

The brain is surrounded by three membranes. The median membrane is arachnoid, represented mainly by vessels. It provides adequate blood supply, lymph drainage and liquorodynamics..

Closest to the GM is the soft shell. It is also involved in the blood supply to the brain, penetrates into all the furrows and crevices and provides a kind of fixation of the integument of the GM.

Between each of the membranes there are spaces partially filled with serous fluid, which, due to injuries or for other reasons, can be filled with blood coming from damaged blood vessels, forming a hematoma..

Causes In addition to injury, other causes of hemorrhage may include:.

Deformation, changes in the structure of cerebral vessels, which occurs as a result of chronic or other diseases, including autoimmune ones (aneurysm, arteriovenous malformation, cerebral amyloid angiopathy).

Uncontrolled arterial hypertension, hypertensive crisis.

Primary or metastatic tumor processes of GM.

Long-term uncontrolled intake of anticoagulants (Warfarin, Acetylsalicylic acid, etc.).

Hematological diseases (hemophilia, oncohematology, sickle cell anemia).

Types of hematomas Depending on the location, the following forms of hemorrhages of the GM are distinguished:.

Kinds.

Description.

epidural.

Formed in a space bounded by the outer surface of the hard shell and the inner surface of the skull.

Subdural.

The spilled blood accumulates between the hard and arachnoid membrane.

Intracerebral.

Formed as a result of hemorrhage into the brain tissue, sometimes with a breakthrough into the ventricles and the formation of ventricular hemorrhage.

Subarachnoid.

Accumulation of blood in the subarachnoid space.

From a damaged vessel, blood can saturate the very substance of the brain, in which case they talk about intracerebral hemorrhage.

Types of subdural hematomas according to the clinical course:.

Kinds.

Description.

Acute.

Characteristic symptoms develop immediately after injury or exposure to a damaging factor..

subacute.

In this case, the clinical picture is not immediately obvious, but manifests itself within a few hours..

Chronic.

A person with a chronic subdural hematoma can walk for months, and in rare cases, for years, unaware of his disease, due to the absence of characteristic clinical signs..

Epidural hematoma Forms over the dura and can reach up to 8 cm in diameter, accumulating an average of 80-120 ml of blood (sometimes up to 250 ml). Due to the detachment of the dura mater from the bones of the skull, it has a characteristic appearance of a biconvex lens, in which there is a decrease in size from the center to the periphery.

An epidural hematoma forms over the dura mater; in the subdural form, blood accumulates between the dura and arachnoid membranes. An interesting fact is that subdural hemorrhages almost never occur in children under two years of age and in people over 60 years of age due to the tight attachment of the dura mater to the bones of the skull.

Most often they are formed in men aged 16–25 years, in patients of the opposite sex they are observed less frequently (more than 2 times)..

Epidural hemorrhage is the least common, it accounts for 1–1.5% of all intracranial hematomas, however, in case of an accident, the percentage increases to 9%.. In severe DPT, a combination with contusion of the brain and subdural hemorrhage is possible..

Symptoms A characteristic clinical picture is the presence of a light period, during which the patient loses consciousness for a short time, and after recovery complains of moderate cephalgia, dizziness, weakness. Objectively, amnesia, anisoreflexia, nystagmus, mild meningeal symptoms can be observed..

Pathology is accompanied by headache and weakness. This condition is regarded as mild or moderate traumatic brain injury.. However, after the expiration of the light period (on average, from half an hour to several hours), symptoms increase sharply, headache intensifies, vomiting is observed..

Consciousness suddenly worsens, up to sopor (subcoma) and coma. Objectively, there is a decrease in heart rate, an increase in blood pressure, unilateral mydriasis (on the side of hemorrhage), paresis of the facial nerve and other focal signs indicating compression of the GM.

Erased light gap The process can proceed with an erased light gap. In this case, the absence of consciousness, coma is immediately noted.. Then, after some time (several hours), consciousness begins to recover to a stupor, sometimes verbal interaction with the patient is possible, in which he can indicate a severe headache.

In this state, the patient can be from several minutes to 24 hours, after which the symptoms, as in the first case, progressively and sharply worsen, the stupor turns into excitement, and then into a coma.. Objectively, severe vestibular, neurological and other disorders are noted, indicating damage to the brain stem. Vital functions progressively worsen.

Absence of a light period The absence of a light period is a rather rare phenomenon in which immediately after an injury the patient is in a coma without changing his consciousness.. This is a poor prognostic sign observed in severe traumatic brain injury in combination with other brain damage..

Subdural hematoma In this case, blood from damaged vessels accumulates between the dura and arachnoid meninges. In frequency, it is about 40% of all intracranial hematomas..

Symptoms At the forefront are signs of impaired consciousness, mentality, headaches and vomiting.

Classically, the symptoms of hemorrhage are three-stage, in which at first there is an absence of consciousness, then a short-term light interval follows (partial recovery of consciousness), which is replaced again by an absence of consciousness, the onset of coma. However, such staging is rarely observed, often the light gap is either erased or completely absent..

Other clinical symptoms:.

amnesia;

delirious, oneiric syndrome;

euphoria, absurd behavior, arousal;

epileptic seizures;

headache, dizziness, increased sensitivity to light;

dilation of the pupil on the side of the hemorrhage;

other symptoms of brain compression;

focal symptoms.

Intracerebral hematomaRepresented by a limited accumulation of liquid or clotted blood (1-100 ml) in the GM substance.

With an intracerebral form of hematoma, blood accumulates in the substance of the brain. The accumulated fluid in the substance of the brain is characterized by the following clinical signs:.

Compresses surrounding neurons, which inevitably leads to their necrosis.

Leads to increased intracranial pressure and development of brain edema.

It provokes the formation of a dislocation syndrome (in which a large amount of accumulated blood leads to a displacement of the median structures of the brain).

The emerging spasm of vessels located near the hematoma aggravates the course of the process, increasing the area of \u200b\u200bnecrosis. In 15% of cases, blood breaks into the ventricles of the GM (ventricular hemorrhage).

Classify pathology depending on location and size. According to the size of the hematoma, there are:.

small: up to 20 ml, in diameter up to 3 cm;

medium: up to 50 ml, up to 4.5 cm in diameter;

large: more than 50 ml, more than 4.5 cm in diameter.

Symptoms Intracerebral hemorrhage may be accompanied by a three-phase (with the presence of a light gap) or the absence of a light gap. Consciousness in such patients is impaired (spor or coma), which may be preceded by psychomotor agitation.

The severity and presence of focal symptoms will depend on the size and location of the hematoma.. Most often, it is accompanied by unilateral muscle paresis, aphasia, epileptic seizures, violation of the symmetry of tendon reflexes, different pupil diameters.. Also characterized by lack of criticism, amnesia, behavioral disorders.

With a breakthrough of blood into the ventricles of the brain, there is an increase in body temperature, the rapid development of a coma (if the patient was not in a coma before), signs of irritation of the membranes of the brain, specific convulsions are characteristic.

DiagnosisDiagnosis is established by a neurologist or neurosurgeon, often together with a traumatologist.

To make a diagnosis, you need to contact a neurologist or neurosurgeon. To determine the location of the hemorrhage, the severity of the patient's condition and further management tactics, the following clinical and laboratory methods are used:.

Collection of anamnesis, assessment of symptoms, complaints, objective condition.

General clinical blood tests, urine.

X-ray diagnostic methods: allow to identify the location of the fracture (in 90% of cases it coincides with the location of the hematoma).

Magnetic resonance imaging.

Cerebral angiography or magnetic resonance angiography (may indicate the site of a vessel rupture or other vascular abnormality).

TreatmentTherapy can be conservative and operative.

Conservative treatment is carried out with the following hematoma sizes:.

epidural: up to 40–50 ml;

subdural: thickness no more than 1 cm, displacement of cerebral structures up to 3 mm, volume up to 40 ml;

intracerebral: diameter does not exceed 3 cm.

Additional indications for conservative therapy:.

a satisfactory state of consciousness of the patient and the absence of severe symptoms with a tendency to progression;

no signs of GM compression, dislocation syndrome.

Drugs used in treatment:.

to eliminate vasospasm: Aminocaproic acid, Vikasol, Aprotinin, Nifedipine;

to prevent cerebral edema: Mannitol and other symptomatic drugs.

Urgent surgery is often performed, aimed at aspiration of the spilled blood, removal of hematoma and crush foci, if any, elimination of brain compression, ligation of the bleeding vessel.

In some cases, surgery is requiredSurgical intervention should always be accompanied by infusion therapy, including hemostatic, decongestant and other drugs.

Consequences of cerebral hematomaConsequences of cerebral hematoma depend on its location and size, the age of the patient, concomitant diseases, combination with other damage to the brain tissue and its membranes, the duration and degree of impaired consciousness, the timeliness and usefulness of qualified assistance.

The mortality rate for subdural hematomas is 50–90%.. A prognostically favorable outcome is observed during the operation in the first 6 hours after injury.. Mild hematoma often responds well to conservative treatment and resolves within 30–40 days. Cases of chronicity are known.

A quarter of epidural hemorrhages are fatal. With timely conservative therapy or surgery, mortality is minimized..

With intracerebral hemorrhages, the most unfavorable outcome is in the event of a breakthrough of blood into the ventricles.. 70% of patients after treatment have a persistent disabling neurological deficit.

Brain hematoma is a dangerous condition that threatens the life of the patient. The immediacy and adequacy of medical, resuscitation and rehabilitation measures are the most important steps to reduce the risk of death or disability.

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