Brain hematoma and its consequences

Hematoma of the brain - a hemorrhage into the brain, in which a cavity (cavity) is formed, filled with blood. Brain hematoma is a serious disease, very often requiring emergency medical care. Hemorrhage in the brain leads to a defect in the nervous tissue, disturbs its blood supply, the growth of the hematoma is dangerous by squeezing the brain, and this is a real threat to life.

[1], [2], [3]

Causes of the hematomas of the brain

There are following causes of brain hematoma: 

1. Craniocerebral injury of varying severity (with a fall, an accident, a blow to the head). 
2. Various co-morbidities: 
   • neoplasms in the brain (tumors), 
   • infectious diseases of the brain, 
   • abnormalities in the development of the blood vessels of the brain (there may be congenital and acquired - aneurysms, malformations of the arteriovenous vessels of the brain - are characterized by spontaneous occurrence) 
   • Cardiovascular pathology, accompanied by increased blood pressure, 
   • various inflammations of the arteries and veins (for example, in such diseases - lupus erythematosus, nodular periarteritis),
   • blood diseases accompanied by a clotting disorder (with hemophilia, leukemia, certain types of anemia, viral hemorrhagic fever), 
   • severe neurological diseases, 
   • sepsis (getting into the bloodstream and human tissue of infectious agents, in other words - blood infection), 
   • autoimmune changes in the body, accompanied by damage or destruction of healthy tissue and the development of inflammation (for example, in the brain).
3. Treatment with anticoagulant drugs that inhibit the coagulation capacity of blood and thus prevents the formation of thrombi.

[4], [5]

Causes of hematoma of the spinal cord

1. Injury of the spinal cord with: 
   • impacts in the spine, falls, accidents, gunshot wounds; 
   • childbirth;
   • Diagnostic puncture (lumbar or lumbar puncture);
   • epidural anesthesia; 
   • operations on the spinal cord. 
2. Vascular malformations of the spinal cord (aneurysms, malformations). 
3. Tumors or fistulas (syringomyelia) of the spinal cord. 
4. Abscess (purulent inflammation) of the spinal cord and its membranes. 
5. Inflammatory myelitis (inflammation of the spinal cord of an infectious or traumatic genesis). 
6. Violations of blood coagulability, due to the use of anticoagulants, or any disease. 
7. Exhausting physical activity, accompanied by a lifting of gravity. 
8. Arterial hypertension.

[6], [7]

Symptoms of the hematomas of the brain

Symptoms of brain hematoma depend on its size, localization, duration and severity of the process (ie, during what time it was formed). Clinical manifestations can appear immediately after a traumatic injury or after a certain time, and can appear spontaneously (without cause).

The general symptoms of the brain's hematoma are characterized by varying degrees of severity (depending on the location of the hematoma, its size and severity of the process): 

• headache, 
• dizziness, 
• nausea and vomiting, 
• change of coordination of movements, 
• speech disorder (lack of it or deceleration), 
• change in the size of pupils (both or one), 
• violation of gait, 
• there may be convulsions, 
• violations of consciousness of varying degrees of severity (from the clouding of consciousness to its loss).

Symptoms of spinal cord hematoma

The clinical symptomatology depends on the size of the hematoma and its location (along the length of the spinal cord or across it). They include: 

• pain syndrome in the neck, thoracic or lumbar region (depending on the location of the hematoma), 
• neurological disorders in the form of paresis or paralysis of the limbs (partial or complete loss of motor function), 
• conductive sensitivity disorders, due to complete or partial impairment of conduction of the spinal cord. They can be asymmetrical, with paraparesis and with urination disorder,
• violation of temperature and pain sensitivity, 
• possible spinal shock after a spinal cord injury, accompanied by loss of consciousness, a drop in blood pressure and depression of all body functions, 
• hemorrhage in the cervical spinal cord at the level of C8-Th, is accompanied by such symptoms as ptosis (eyelid drooping), miosis (pupil constriction), enophthalmos (displacement of the eyeball inside the orbit) - Horner's syndrome, 
• with the location of the hematoma of the spinal cord at the level of the thoracic segment of the C4 segment, there may be a violation of breathing, up to a stop (due to a violation of the innervation of the diaphragm); 
• hemorrhage in the lumbar region is accompanied by a violation of the function of the pelvic organs (violation of urination, defecation).

With hematoma of the spinal cord, which arose as a result of vascular pathology, pain syndrome and neurologic disorders appear simultaneously.

When the hematoma of the spinal cord, which has arisen for another reason, often there is a gradual appearance of pain syndrome, and neurological disorders develop over time.

[8], [9]

Forms

Distinguish between hematomas of the brain and spinal cord.

Distinguish the following types of hematomas of the brain. 

1. Intraaxillary hematoma (intracerebral) - a hematoma located exclusively in the region of the brain, does not go beyond it. Intra-axillary hematomas include: 
   • hemorrhage into the parenchyma (tissue) of the brain (intraparenchymatous), 
   • hemorrhage into the ventricular system of the brain (intraventricular hematoma). It is often found in preterm infants.
   • Intraaxillar hematoma is more difficult to treat than extraaxillary and therefore more dangerous for life. 
2. Extraaxillary hematoma is a hematoma located inside the skull, but outside of the brain. To such a hemorrhage include its following subspecies: 
   • epidural hemorrhage - localized above the dura mater, 
   • subdural hemorrhage - is located between the dura mater and the arachnoid (arachnoid), 
   • subarachnoid hemorrhage - localized in the subarachnoid space between the arachnoid and soft cerebral membranes.
3. Depending on the size, the hematomas of the brain are classified as follows: 
   • up to 50 ml - hemorrhage of small volume, 
   • from 51 to 100 ml - an average volume hematoma, 
   • more than 100 ml - a large hemorrhage.
4. With the course of brain hematomas are divided into: 
   • acute - clinical manifestations occur up to three days, 
   • subacute - clinical symptoms appear from three to 21 days, 
   • chronic - the clinic appears more than 21 days later.

Brain hematoma

Brain hematoma - intracranial hemorrhage, accompanied by increased pressure in the cranial cavity, a violation of blood circulation in the brain tissue with subsequent damage to it and displacement of the structures relative to each other. Hematoma of the brain often requires surgical intervention to extract it (if the hemorrhage is large, squeezes the brain tissue and threatens the life of a person). In case of a small hemorrhage (up to 50 ml), it is sometimes possible to do without surgery with the help of conservative methods. Intracranial hematomas are formed due to disruption of the integrity of the walls of the blood vessels of the brain.

[10], [11], [12], [13]

Hematoma of the spinal cord

Hematoma of the spinal cord (hematomyelia) - spinal hematoma, at which a hemorrhage occurs in the spinal cord tissue, is rare. This hemorrhage is also dangerous for life, because accompanied by compression of the spinal cord and its roots, and often requires immediate assistance specialist. In the epidural gap of the spinal cord, hemorrhage may be limited or extensive, with the formation of a huge cavity filled with blood, which compresses the adjacent structures of the nervous tissue. Such compression of the nervous tissue is accompanied by a disorder in the function of internal organs.

Subdural hematoma of the brain

Subdural hematoma of the brain - occurs between the dura mater and the arachnoid (arachnoid), due to a change in the integrity of the blood vessels, usually the bridging veins (their rupture).

From the rate of appearance of clinical symptoms, the following forms of subdural hemorrhage are distinguished: 

• acute form - the symptoms appear within three days after a traumatic injury, 
• subacute form - the symptoms occur over a period of four days to two weeks, 
• chronic - clinical symptoms occur after a couple of weeks or months after traumatic injury.

With subdural hemorrhage there is a gradually increasing headache, with time there is nausea and vomiting. As the hematoma rises, cramps, epileptic fits, loss of consciousness are possible. 

• When carrying out a computer tomography, a hematoma of crescent shape is noted. 
• In acute and subacute form of subdural hematoma, surgical intervention is performed - extraction of hematoma

One way or another, the choice of tactics for hematoma therapy depends on its volume, the severity of the process and the severity of the clinical symptomatology.

Epidural brain hematoma

Epidural hematoma of the brain - when a hemorrhage occurred between the dura mater and the skull. Hemorrhage in this place is mainly associated with damage (rupture) of the middle shell artery. Epidural hematoma is very dangerous, as the bleeding from the arterial system is under high pressure, as a result, within a short time, intracranial pressure significantly increases (minutes, hours). 

• The clinical symptomatology of epidural hematoma is characterized by the development of a light interval that arises after a previous loss of consciousness. The light period lasts from a couple of minutes to hours. After that there is a sharp deterioration in the general condition, a pronounced headache develops, vomiting, nervous-motor excitement, passing into paresis and paralysis, and subsequently into loss of consciousness. 
• When examined, usually an enlarged pupil is seen on the side of the hemorrhage (three times more than the opposite). 
• When carrying out computed tomography of epidural hematoma, its biconcave form is noted. 
• With epidural hematoma requires immediate surgical intervention, t. Such a hematoma strongly squeezes the brain tissue, which causes irreversible disturbances in it.

Mortality with epidural hemorrhage is high enough.

[14], [15], [16], [17]

Subarachnoidal hematoma of the brain

Subarachnoidal hematoma of the brain - hemorrhage occurs in the subarachnoid space, located between the arachnoid and soft cerebral membranes. Subarachnoid hematoma ranks third in the structure of cerebral strokes. 

• The classic manifestation of subarachnoid hemorrhage is an acute headache resembling a severe blow to the head. There is nausea, repeated vomiting, psychomotor agitation, impaired consciousness up to the coma, there is the emergence and growth of meningeal symptoms - rigidity of the occipital muscles, fear of light and loud sounds, etc. (due to irritation of the brain membranes). 
• When carrying out a computer tomography, the blood in the furrows is determined, with the filling of the arachnoid cisterns.

Subarachnoid hemorrhage often requires surgical intervention.

Chronic hematoma of the brain

Chronic hematoma of the brain is a hemorrhage distinguished by the presence of a restrictive capsule. Subdural chronic hematomas are isolated.

Chronic subdural hemorrhage occurs in 6% of cases in the volume formations in the brain. The hematoma capsule begins to function a few weeks after the subdural hemorrhage. The duration of this period is used to distinguish chronic hematomas from acute and subacute forms. 

• The process of capsule formation is quite long and can last from several months to several years. 
• The capsule of subdural hemorrhage consists of connective tissue fibers and newly formed vessels. 
• The volume of such a hematoma can increase when new injuries occur. On average, it is about 100 ml.

In chronic subdural hematoma, 25% of people do not recall the trauma that caused it (mostly elderly people). Trauma can be of an easy nature, and after a while (weeks, months) there is: 

• headache, the nature of which, can change with a change in the position of the body,
• retardation, 
• impaired consciousness, 
• change of personality, 
• epileptic seizures.

Headaches in combination with progressive dementia (dementia) suggest a chronic subdural hematoma.

Also, a chronic brain hematoma, increasing in size, can simulate a brain tumor.

Treatment of such hematomas is mainly surgical.

[18], [19], [20], [21]

Brain hematoma in newborns

The hematoma of the brain in newborns is due to: 

• birth trauma, 
• intrauterine hypoxia (oxygen starvation), the consequence of which are severe disorders of hemodynamics, 
• violations of the blood coagulation system.

The clinical picture of intracranial hemorrhage in newborns differs from that of adults. In a newborn, intracranial hematoma can manifest only anemia on the background of increased intracranial pressure.

Signs of increased intracranial pressure in the newborn: 

• anxiety; 
• frequent regurgitation, not associated with eating; 
• tension of the large fontanel and its bulging; 
• change scream.

A sudden and progressive deterioration in the condition of the newborn or a stably serious condition, accompanied by periods of excitement and depression, should be a cause for concern about the presence of an intracerebral hematoma. This requires a thorough examination of specialists (neurologist, pediatrician, neurosurgeon) and computer tomography of the brain. When confirming the presence of an intracerebral hematoma, its removal is performed.

Another type of hematoma in newborns is the cephalohematoma. Kefalogematoma occurs due to traumatization of the bones of the skull during childbirth. It is a hemorrhage between the flat bones of the skull and the periosteum (connective tissue). In general, cephalohematomas are located in the parietal areas. It gradually increases in the first two or three days of life. The size of the cephalohematoma can be from five to 140 ml. 

• If the cephalohematoma is small in size, then it gradually dissolves itself (within two to four weeks). 
• If the cephalohematoma of large size or long dissolves, then it is removed, tk. It can be complicated by suppuration, calcification, anemia.

[22], [23], [24], [25], [26]

Complications and consequences

The consequences of brain hematoma - the most diverse, it all depends on the severity of damage, the location of the hematoma, its size and the timeliness of medical care. They can be very heavy or light. In the light and moderate cases of brain hematomas, recovery and complete restoration of the body functions occur.

In severe conditions, such consequences of hematoma can be noted. 

1. Syndrome of chronic fatigue (asthenia), depression, sleep disorders. 
2. Cognitive disorders: memory problems (forgetfulness, new material is poorly remembered), there may be a mental disorder, a deterioration in mental activity, possibly a disruption in the ability to acquire and assimilate new information. 
3. Speech disorders can be: difficulty in speaking and understanding speech, difficulty in reading, writing and counting (left brain hemisphere). 
4. There may be movement disorders, weakness in the limbs, paralysis complete or partial, disruption of coordination of movements is possible. 
5. Perceptual disorders, for example, when a person with an excellent vision does not understand what he sees, i.e. Can not reproduce what he saw. 
6. Behavior may change: tearfulness, the emergence of unmotivated aggression or fear, irritability, emotional lability (instability) - laughter, sharply can be replaced by crying and vice versa. 
7. Post-traumatic convulsions (epilepsy) are possible. 
8. Disorders of the function of urination and defecation (delay or incontinence of urine, feces). 
9. Swallowing disorders, frequent pinches can be noted.

[27], [28], [29], [30], [31]

Consequences of hematomas in newborns

The consequences of hematomas in newborns may be favorable and result in complete recovery, or may be unfavorable.

Adverse effects of hematoma (mostly such children are very painful). 

• Delay in mental and physical development. 
• The formation of motor skills occurs with delay. 
• Possible development of hydrocephalus. 
• Cerebral palsy. 
• Violation of coordination of movements. 
• Epileptiform cramps. 
• Mental disorders.

[32], [33], [34], [35], [36]

Diagnostics of the hematomas of the brain

Diagnosis of brain hematoma is based on the history of the disease (clinical history), clinical symptoms and data from additional survey methods. Since hemorrhages in the brain pose a threat to life, they often need specialized medical help.

Therefore, in the presence of head trauma, accompanied by loss of consciousness and with other symptoms of hemorrhage, you urgently need to contact a specialist (neurosurgeon, neurologist). In case of suspicion of the presence of brain hematoma in order to determine its location, dimensions and intracranial pressure, carry out: 

• Computer tomography (CT) -tomographic study using X-ray radiation; 
• Magnetic resonance imaging (MRI) is a modern study using a magnetic field and radio waves to create images of tissues and organs on a computer monitor. 
• Echoencephalography (EEG) - ultrasound is used for diagnosis. 
• Cerebral angiography and angiography of the vessels of the spinal cord. 
• If necessary, a lumbar puncture is performed, especially if there is a hematoma of the spinal cord.

[37], [38], [39], [40], [41], [42], [43]

Treatment of the hematomas of the brain

Treatment of brain hematoma is often surgical, less conservative. Conservative therapy is performed if the hematoma is small and does not endanger life, and also after surgery.

In any case, with hematoma of the brain, bed rest is needed. Conservative therapy of brain hematoma is aimed at preserving and supporting vital body functions. Symptomatic therapy is performed.

• With severe headache, analgesics (analgin, ketones) are prescribed.
• If there is vomiting - antiemetics - cerucal (metoclopramide). 
• With a strong stimulation, neuroleptics, tranquilizers (phenazepam, diazepam) are used. 
• When respiratory depression, artificial ventilation is carried out (IVL). 
• Mannitol is prescribed to reduce brain edema. 
• To prevent repeated bleeding, prescribe antifibrinolytic therapy - countercial, vicasol, aminocaproic acid. 
• To prevent vasospasm, calcium channel blockers, such as phenygidine, vitamin E, corticosteroids, are prescribed. 
• To improve microcirculation and blood properties are introduced - heparin, pentoxifylline. 
• In the recovery period nootropic drugs are prescribed - piracetam, aminalon. 
• Vitamins of group B and multivitamins (multitabs, multifort).

Operation

To determine whether an operation is necessary for brain hematoma, you need to know this: 

• causes of hemorrhage; 
• a neurological condition of a person; 
• make the necessary examination;
• assess the dynamics of hemorrhage and clinical symptoms.

1. With subdural hemorrhage, urgent surgical intervention is often performed.

It can be bone-plastic or resection trepanation. A trephine hole is made, through it a solid shell of the brain of the cyanotic color is visible and can pulsate faintly. It is carefully opened, blood and clots are removed using a spatula, isotonic sodium chloride solution and moist cotton swabs. Eliminate the cause of bleeding, and then sew a hard shell (lay a bone graft and sew on layers, renewing the covers). To have a wound outflow of blood and tissue fluid, previously placed the drainage for 24 hours. Subdural hematoma can be removed and endoscopically, through a small hole.

If the subdural hematoma is small and the patient feels well, then under the control of MRI or CT, the operation can be abstained. Usually hematomas of such sizes dissolve in a month under the influence of conservative therapy.

2. With epidural hemorrhage, as a rule, an emergency operation is also necessary. This kind of bleeding is the most dangerous because of arterial bleeding.

With a very active flow of the process (the clinical symptomatology of brain compression increases), a milling hole is first made and the hematoma is partially removed, reducing the compression of the brain. Subsequently, bone-plastic trepanation is performed (cut out the bone flap), which allows to completely remove the hematoma and stop the bleeding.

If there is a dirty wound in the area of epidural hemorrhage and many small bone fragments, resection is performed.

Removal of brain hematoma

Removing the brain's hematoma is basically an unavoidable method of hematoma therapy. Brain hematomas of large size that threaten the patient's life are removed. Hematoma of the brain is removed under general anesthesia by a neurosurgeon. After removal of the brain's hematoma requires a long period of complex treatment and rehabilitation. Timely removal of the hematoma of the brain increases the patient's chances of recovery.

Treatment of hematoma of the spinal cord

Treatment of the hematoma of the spinal cord is complex, often conservative. 

1. Full bed rest. 
2. In order to stop bleeding appoint: aminocaproic acid, vikasol (coagulants - increase blood coagulability). 
3. If urination is impaired (delay), the bladder is catheterized. 
4. In the recovery period prescribe anticholinesterase drugs (proserine, galantamine) - improves and restores neuromuscular conduction. 
5. Vitamins of group B - improve metabolic processes in the cell. 
6. Assign neuroprotectors and nootropic drugs (piracetam, aminalon, cerebrolysin). 
7. Often, with hematomas of the spinal cord, antibacterial agents are prescribed to prevent the development of a secondary infection (cystitis, pyelonephritis, pneumonia) - ceftriaxone, sumamed. 
8. In the recovery period - therapeutic exercise, massages.

Prevention

Prevention of brain hematoma is as follows. 

1. Avoid injury to the brain (do not take part in fights, exclude traumatic sports, ride neatly on a car, etc.). 
2. Do not abuse alcohol. 
3. Do not use uncontrolled medicines (eg, aspirin). 
4. To be engaged in therapy of concomitant diseases: to eliminate high blood pressure, not to allow the occurrence of anemia - to eat well and rationally. 
5. If, nevertheless, brain trauma has occurred, it is necessary, as soon as possible, to seek help from a specialist (neurologist, neurosurgeon). 
6. Pass regular preventive examinations and a comprehensive examination of the entire body, at least once a year.

Prevention of hematomas of the brain in newborns. 

• Timely detection and treatment of a pathological condition in a pregnant woman and a fetus. 
• Competent management of childbirth.

[44], [45], [46], [47], [48], [49],

Forecast

The prognosis of brain hematoma depends on many factors. From the size of the hematoma and its location, the severity of the process, the timeliness of seeking help and its delivery. Acute cases of epidural and subdural hematomas very often have an unfavorable outcome. With small hematomas, mild to moderate hemorrhages, the prognosis is usually favorable. The process of recovery and recovery of the body's functions with brain hematomas is often lengthy, sometimes lasting for years.

[50], [51], [52], [53], [54], [55], [56]