Urgent!!! Subdural hematoma of the temporal parietal skull under the internal skull

Look at the size of the hematoma, half of the children to 2 years old fontanelle has been closed, so there is no big difference with adults, if the hematoma does not cause intracranial pressure is not a big problem, wait for him to slowly absorb it, as for the sequelae, the situation is not serious, there should be nothing. In terms of nursing, there is nothing to do, just pay attention to the changes in the child's pupils and breathing, and worry about the formation of brain herniation caused by high intracranial pressure, and pay attention to whether there is vomiting and aggravated headache, which are all manifestations of intracranial hypertension.

It's okay, the hematoma will absorb on its own, and if it's not good after discharge, let's talk about it. As long as it doesn't hurt brain cells, it's okay to do it soon. Within 15 days to 30 days.

How much does the bleeding take?

Usually.

Patients with a temporal hematoma volume of less than 20 mL and a hematoma thickness of less than 10 mm are more likely to be conservative**.

However, if the hematoma volume is greater than 25ml and the hematoma thickness is greater than 15mm, surgery is more often performed**.

There will be some sequelae.

Traumatic brain epilepsy is more common.

Vascular malformations at the site of injury may also be present.

Other neurologic symptoms may also be seen.

The acute phase is usually around seven to fifteen days.

Cerebral edema is severe at this stage.

If edema is not well controlled.

May cause intracranial hypertension.

It can even induce brain herniation.

Usually, there is no longer a danger after the acute phase.

But it's not absolute.

In the acute stage, attention should be paid to adverse conditions such as changes in consciousness and pupils.

Prevents intracranial pressure from being too high and inducing brain herniation.

Discharge from the hospital can usually be considered after the risk period has been overcome.

1. To ensure that the fracture can be restored to function as much as possible, reduction plus necessary fixation is the key. Later care should also be dealt with around immobilization. First of all, after the fracture, it is necessary to check whether the fixation is too loose or too tight, and if it is too loose, you should go to the hospital to find a doctor to tie it tightly, too tight will affect the blood circulation of the limbs, and you should also go to the hospital to find a doctor to deal with it.

Try to move the affected limb as little as possible, pay attention to the blood circulation of the fingers, and if there is numbness, it means that the fixation is too tight.

It is advisable to eat more calcium-containing foods such as soy products, seafood, milk, eat more fresh fruits, and bask in the sun to supplement vitamin D, which helps to absorb calcium.

Epidural hematoma has a clear history of trauma, and post-injury consciousness changes may have an intermediate waking period, and CT shows a convex lens-shaped hyperdense shadow under the inner plate of the skull; Subdural hematoma has a history of trauma that is not obvious, and may have mental and memory loss, psychiatric or personality abnormalities, etc. CT shows a crescent-shaped mass lesion that is widely distributed across multiple lobe surfaces under the inner plate of the skull.

Epidural hematomas are mainly acute, accounting for about 86%, and sometimes complicated by other types of hematomas. Hematoma generally occurs at the point of force and its vicinity, so the location of the hematoma can be judged according to the location of the fracture line through the meningeal vessels and venous sinuses. Epidural hematoma caused by injury to the middle meningeal artery accounted for 3 4, followed by injury to the venous sinus and plate barrier vein.

Hemorrhage accumulates at the separation of the dura from the internal skull plate and further separates the dura as the hematoma grows.

Epidural hematomas are most common in the frontotemporal and parietotemporal regions, which are related to the fact that the temporal region contains middle meningeal arteries and veins, and is easily torn by fractures. Rapidly developing epidural hematoma, whose bleeding** is mostly caused by arterial injury, the hematoma increases rapidly, can cause cerebral herniation within a few hours, threatening the patient's life. If the bleeding originates in a vein, such as a dural vein, plate barrier vein, or venous sinus, the disease progresses slightly more slowly and may be subacute or chronic.

Acute epidural hematomas are less common in the occipital region because the dura is lightly attached to the occipital bone and is often venous. According to research, a hematoma requires at least 35 g of force to detach the dura from the skull. Sometimes, however, a large epidural hematoma that straddles the sinus can also occur because the fracture line crosses the superior sagittal or transverse sinus, and the continuous expansion of this hematoma is usually caused by new rebleeding after the dura mater is dislodged from the inner bony plate, rather than by venous pressure alone.

The size of the hematoma is closely related to the severity of the disease, and the larger it is, the more severe it is. However, the relationship between bleeding velocity and clinical manifestations should not be ignored. Symptoms of cerebral compression often appear early in small and acute hematomas, while slow-bleeding hematomas begin to present with increased intracranial pressure over days or even weeks.

An acute hematoma located on the convex surface of the hemisphere often pushes down the brain tissue, causing the hippocampus and uncinate gyrus protrusion on the medial aspect of the temporal lobe to below the tentorial notch margin, compressing the cerebral foot, oculomotor nerve, and posterior cerebral artery, and affecting the return of the pontine vein and superior petrosal sinus, which is called tentorial herniation. Epidural hematomas, which are long-lasting, usually become organic within 6 to 9 days, grow from the dura into fibroblasts and are surrounded by a thin layer of granulation and adhesion to the dura and skull. Small hematomas may be fully organizing, while large hematomas may become cystic and contain brown bloody fluid.

Now it is definitely not possible to be discharged, there is a hematoma in the skull, but the amount is not much, otherwise the doctor will do the operation, the patient is now conscious clearly, indicating that the hematoma has not been further expanded, but the possibility of expansion is not ruled out, in addition to the skull fracture, there is gas in the skull, indicating that it is an open fracture, intracranial infection must be prevented, if there is no cerebrospinal fluid leakage, you can try to sit semi-sitting, if there is not, at present or continue to observe the condition, generally about 7-14 days, if the re-examination CT hemorrhage has been absorbed, you can be discharged, Follow-up examination after 1 month.

This is a typical manifestation of traumatic epidural hematoma + cerebral contusion + basilar skull fracture, and the following principles are conservative and effective: 1. Absolutely lie flat for 2 weeks; 2. Strengthen nutrition; 3. Prevent infection;

1. There is no good way to get good quickly, recovery after injury is a natural process, and it is good to be able to develop.

2. You don't have to lie down, how to sleep comfortably.

Good luck soon**!

Look at the length of hospitalization, see how much bleeding, brain contusion, if the doctor says no surgery, take medication**. No matter how short it is, it will not be less than 10 days; Whether to lie down or not depends on whether there is a cerebrospinal fluid leak, and if there is, it must be semi-lying; If you have gas, you have to pay attention: you can't cough hard, you can't urinate forcefully, and you can't blow your nose hard.

If you know this, you can go home!

When the fracture heals has nothing to do with the length of hospital stay.

If the indication for surgery is reached, the surgery should be performed as soon as possible, and the internal medicine must be conservative**, and it must be lying flat.