Conservative treatment of chronic subdural hematoma, chronic subdural hematoma

Chronic subdural hematoma is a person who has an intracranial hemorrhage in which blood accumulates in the subdural space and symptoms develop more than three weeks after injury. At present, there is no unified understanding of the hemorrhage** and pathogenesis of hematoma. Its incidence accounts for about 10 percent of intracranial hematomas, which often occur on the convex surface of the frontoprietal temporal hemisphere, and the amount of blood can reach 100-300 ml.

The clinical manifestations are mainly increased intracranial pressure, headache is more prominent, some have mental symptoms such as dementia, apathy and mental retardation, and a few may have local brain symptoms such as hemiplegia, aphasia and localized epilepsy.

There is often a history of minor or neglected head injuries, and symptoms often appear more than 3 weeks after the injury. Even straining to have a bowel movement can happen.

Whether the patient has fallen or not, generally the subdural hematoma is closely related to trauma.

This is not necessarily, now according to the situation, considering that there is a case of capillary rupture, it is recommended that it is best to do a platelet examination

Chronic epidural hematomas most often have a history of head trauma, but this is not absolute. For some people, this can also happen with a sudden shaking of the head.

The surgery was considered to be "borehole hematoma drainage", which only removed the hematoma and did not treat the bleeding point. If the bleeding continues, go to the hospital as soon as possible for a craniotomy to remove the bleeding point. Cure the root cause.

Hello, causes of cerebral hemorrhage: hypertension, cerebrovascular malformations, traumatic brain injury. These agricultural protection will know, don't worry, the important thing is to be positive in the early days**.

Chronic sub-hard hematoma does not have to be impacted by external force, and many of them are unknown.

Surgery** is recommended, with puncture and drainage of chronic subdural hematoma, which can be performed under local or general anesthesia with little risk.

The fluid that invigorates blood and nourishes nerves can be hung.

The relatively simple is the drilling and drainage of the suction needle, local anesthesia, simple and easy, and the risk of surgery is very small.

Acute subdural hematomas (blood accumulation between the dura mater and arachnoid membranes, usually due to bleeding from rupture of a graft vein) and intracerebral hematomas are common in severe head trauma. Combined with severe cerebral edema, they are the cause of death in most cases. All three conditions can cause herniation through the tentorial notch of the cerebellum, resulting in progressive deepening of coma, widening of pulse pressure, moderately large or dilated pupils with loss of response to light, tonic hemiplegia with hyperreflexia, rigidity of the extremities, and decortical or decerebrosis (due to progressive neurologic deficits that extend from the head downward).

CT or MRI usually shows some lesions that are operational**. Surgical removal of large hematomas may be lifesaving, but disability after trauma is often high.

Acute subdural hematoma is a buildup of blood between the dura mater and arachnoid mater, and is more common in severe head trauma, often coexisting with cerebral contusion and intracerebral hematoma. It is the leading cause of death from traumatic brain injury. By causing cerebral herniation, the patient is comatose, consciousness is deepened, pupils are dilated with loss of response to light, and cortexal or decreebrate rigidity.

CT usually shows some lesions that can be surgically applied**, and MRI is not recommended in the acute phase. Emergency surgical removal of a large hematoma may be lifesaving, but the disability rate is high.

Simply put, it is an intracranial hemorrhage caused by trauma or other reasons, and the hematoma is located under the dura mater and above the arachnoid membrane. The hematoma is often a crescent-shaped, high-density opacity, with a prominent mass effect, and the surrounding edema zone is often obvious. It is commonly seen in head injury, cerebral contusion, bridge vein rupture, malformation, hemangioma, etc.

In general, if there is a small amount of hematoma without obvious neurolocalizing signs, the patient's vital signs are stable, and there are no landmarks for neurosurgery, it is feasible to be conservative** and closely observe the patient's vital signs, consciousness, and pupil changes. Patients with severe contraindications to anesthesia or patients who are physically unsuitable for surgery can also be conservative**. However, patients with heavy bleeding, severe neurological dysfunction or neurolocalizing signs, unstable vital signs, and no serious contraindications to anesthesia should undergo surgery promptly**.

Acute subdural hematoma progresses rapidly and often requires surgical removal of the hematoma. The size of the hematoma, the level of intracranial pressure, the degree of concomitant injury, and the patient's clinical presentation are all indications for surgery. In general, CT shows a hematoma thickness of more than 5 mm, and patients with significant mass effect and midline displacement require emergency surgery to remove the hematoma.

Acute subdural hematoma with low hemorrhage, no progressive deterioration of consciousness, hematoma thickness < 10 mm, midline displacement < 5 mm, can be temporarily non-surgical**.

[Acute subdural hematoma] refers to the subdural hematoma in the brain, and symptoms appear within 3 days after injury, which is the most common intracranial hematoma in traumatic head injury, with an incidence of up to 70%. It mostly occurs on the basis of cerebral contusion, and is more likely to occur in the frontotemporal parietal region, and can be at the corresponding site or hedge site of the external force. Acute subdural hematoma, especially in very acute cases, develops rapidly, is severe, and has a mortality rate of up to 50% to 80%.

Common**] Accelerated sexual violence displaces brain tissue from the fixed dura.

1.Surgery**: Closed drainage of skull drilling, infants and young children can be drained by fontanelle puncture.

2.Symptomatic support**. 1.Symptomatic treatment is sufficient for patients with mild symptoms.

2.Antipsychotic drugs are given to people with mental disorders, and antiepileptic drugs are given to people with epilepsy.

3.Patients with elevated intracranial pressure are given dehydrating hydrouretic drugs to reduce intracranial pressure.

4.Infants and young children should be given hemostatic drugs, especially vitamin K.

5.The patient was given an appropriate amount of antibiotics after surgery to prevent the occurrence of infection.

6.Strengthen support** and prevent complications for critically ill patients.

(1) Causes of CSDH in the elderly The most important cause of CSDH in the elderly is craniocerebral trauma, brain atrophy and anticoagulation, antiplatelet drugs and other factors involved in its pathogenesis. Young and middle-aged patients often need moderate to severe trauma to cause the disease, while the elderly are prone to falls due to slow movement and inconvenience, and minor trauma can cause severe CSDH. Traumatic brain injury mainly injures a pontine vein or cortical venule and causes bleeding.

Cerebral atrophy is prevalent in older people, which can enlarge the subarachnoid space and increase the vulnerability of the bridging veins to relative elongation and filling. Cerebral atrophy also makes the cranial cavity relatively enlarged, and the bridging veins tend to tear or rupture and bleed when the head accelerates or slows down. The intracranial pressure in the elderly is relatively low, and once a small amount of subdural hemorrhage occurs, it is not easy to stop on its own, and it is easy to form a hematoma and produce a capsule.

The neocapillary endothelium in the capsule secretes excessive tissue plasminogen activator (TPA), resulting in local hyperfibrinolysis; Coupled with the application of anticoagulant and antiplatelet drugs, it is easy to cause capsular neovascularization and rebleeding, resulting in the continuous expansion of hematoma. This is the reason why mild head injuries in older people tend to produce significant CSDH. (2) Pathogenesis The main cause of CSDH in the elderly is that it is easy to fall due to inconvenient mobility, and minor trauma can lead to this disease.

In addition, the increased relative movement of the brain and skull can easily cause tears in the bridging veins, which can occur even under mild violence, resulting in a simple subdural hematoma.