A brain hematoma and its consequences

Brain hematoma is a hemorrhage into the brain, which forms a cavern (cavity) filled with blood. Brain hematoma is a serious disease, very often requiring emergency medical care. Brain hemorrhage leads to a defect in the nervous tissue, disrupts its blood supply, the growth of the hematoma is dangerous due to compression of the brain, and this is a real threat to life.

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Causes brain hematomas

The following causes of brain hematoma are identified:

1. Traumatic brain injury of varying severity (from a fall, accident, blow to the head).
2. Various concomitant diseases:
   • neoplasms in the brain (tumors),
   • infectious diseases of the brain,
   • anomalies in the development of blood vessels of the brain (can be congenital and acquired - aneurysms, malformations of arteriovenous vessels of the brain - are characterized by spontaneous occurrence),
   • cardiovascular pathology accompanied by increased blood pressure,
   • various inflammations of arteries and veins (for example, in such diseases as lupus erythematosus, periarteritis nodosa),
   • blood diseases accompanied by coagulation disorders (in hemophilia, leukemia, some types of anemia, viral hemorrhagic fever),
   • severe neurological diseases,
   • sepsis (the entry of infectious agents into the bloodstream and human tissue, in other words, blood poisoning),
   • 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, which inhibit the clotting ability of the blood and thus prevent the formation of blood clots.

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Causes of spinal cord hematoma

1. Spinal cord injury in:
   • blows to the spine, falls, accidents, gunshot wounds;
   • childbirth;
   • diagnostic puncture (lumbar or lumbar puncture);
   • epidural anesthesia;
   • spinal cord surgeries.
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 infectious or traumatic origin).
6. Blood clotting disorders due to the use of anticoagulants or any disease.
7. Exhausting physical activity involving heavy lifting.
8. Arterial hypertension.

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Symptoms brain hematomas

Symptoms of a brain hematoma depend on its size, location, duration and severity of the process (i.e., how long it took to form). Clinical manifestations may appear immediately after traumatic injury or after a certain time, or they may appear spontaneously (without cause).

General symptoms of a brain hematoma are characterized by varying degrees of severity (depending on the location of the hematoma, its size and the severity of the process):

• headaches,
• dizziness,
• nausea and vomiting,
• change in coordination of movements,
• speech disorders (absence or slowness of speech),
• change in pupil size (both or one),
• gait disturbance,
• convulsions are possible,
• disturbances of consciousness of varying degrees of severity (from clouding of consciousness to its loss).

Symptoms of spinal cord hematoma

Clinical symptoms depend on the size of the hematoma and its location (along the spinal cord or across it). These include:

• pain 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 sensory disturbances, due to complete or partial disruption of spinal cord conductivity. They may be asymmetrical, with paraparesis and with urination disorders,
• disturbances of temperature and pain sensitivity,
• spinal shock is possible after a spinal cord injury, accompanied by loss of consciousness, a drop in blood pressure and suppression of all body functions,
• hemorrhage in the cervical spinal cord at the level of C8-Th, accompanied by symptoms such as ptosis (drooping eyelids), miosis (narrowing of the pupil), enophthalmos (displacement of the eyeball into the orbit) - Horner's syndrome,
• if the spinal cord hematoma is located at the level of the thoracic C4 segment, breathing may be impaired, even to the point of stopping (due to impaired innervation of the diaphragm),
• Hemorrhage in the lumbar region is accompanied by dysfunction of the pelvic organs (impaired urination, defecation).

In case of a spinal cord hematoma that occurs as a result of vascular pathology, pain syndrome and neurological disorders appear simultaneously.

In the case of a spinal cord hematoma that occurs for another reason, a gradual onset of pain syndrome is often observed, and over time, neurological disorders develop.

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Forms

A distinction is made between hematomas of the brain and spinal cord.

The following types of cerebral hematomas are distinguished.

1. Intraaxillary hematoma (intracerebral) – a hematoma located exclusively in the brain area, does not extend beyond its boundaries. Intraaxillary hematomas include:
   • hemorrhage into the parenchyma (tissue) of the brain (intraparenchymatous),
   • hemorrhage into the ventricular system of the brain (intraventricular hematoma). Often found in premature babies.
   • An intra-axillary hematoma is more difficult to treat than an extra-axillary one and, accordingly, is more life-threatening.
2. Extraaxillary hematoma is a hematoma located inside the skull, but outside the brain. The following subtypes belong to this type of hemorrhage:
   • epidural hemorrhage - localized above the dura mater,
   • subdural hemorrhage - located between the dura mater and the arachnoid (arachnoid) membrane,
   • subarachnoid hemorrhage - localized in the subarachnoid space between the arachnoid membrane and the pia mater.
3. Depending on their size, brain hematomas are classified as follows:
   • up to 50 ml – small volume hemorrhage,
   • from 51 to 100 ml - medium volume hematoma,
   • more than 100 ml – major hemorrhage.
4. According to the course of the disease, brain hematomas are divided into:
   • acute - clinical manifestations occur within three days,
   • subacute - clinical symptoms appear from three to 21 days,
   • chronic – clinical symptoms appear after more than 21 days.

Brain hematoma

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

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Spinal cord hematoma

Spinal cord hematoma (hematomyelia) - a spinal hematoma, in which bleeding occurs in the spinal cord tissue, is quite rare. Such bleeding is also life-threatening, as it is accompanied by compression of the spinal cord and its roots, and often requires immediate assistance from a specialist. In the epidural space of the spinal cord, bleeding can 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 of the function of the internal organs.

Subdural hematoma of the brain

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

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

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

With subdural hemorrhage, a gradually increasing headache is observed, with nausea and vomiting appearing over time. As the hematoma grows, convulsions, epileptic seizures, and loss of consciousness are possible.

• A computed tomography scan revealed a crescent-shaped hematoma.
• In acute and subacute forms of subdural hematoma, surgical intervention is performed - hematoma extraction

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

Epidural hematoma of the brain

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

• The clinical symptoms of epidural hematoma are characterized by the development of a clear interval that occurs after the previous loss of consciousness. The clear interval lasts from a couple of minutes to hours. After which there is a sharp deterioration in the general condition, severe headache develops, vomiting appears, neuromotor excitation turns into paresis and paralysis, and subsequently into loss of consciousness.
• On examination, a dilated pupil is usually noted on the side of the hemorrhage (three times larger than on the opposite side).
• When performing a computed tomography scan of the epidural hematoma, its biconcave shape is noted.
• In case of an epidural hematoma, immediate surgical intervention is required, since such a hematoma strongly compresses the brain tissue, which causes irreversible damage to it.

The mortality rate for epidural hemorrhage is quite high.

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Subarachnoid hematoma of the brain

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

• The classic manifestation of subarachnoid hemorrhage is a severe headache, reminiscent of a strong blow to the head. Nausea, repeated vomiting, psychomotor agitation, impaired consciousness up to coma are noted, the emergence and increase of meningeal symptoms is observed - rigidity of the occipital muscles, fear of light and loud sounds, etc. (due to irritation of the membranes of the brain).
• When performing computed tomography, blood is detected in the grooves, filling the arachnoid cisterns.

Subarachnoid hemorrhage often requires surgical intervention.

Chronic cerebral hematoma

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

Chronic subdural hemorrhage occurs in 6% of cases among space-occupying lesions in the brain. The hematoma capsule begins to function several weeks after the subdural hemorrhage. The duration of this period is used to differentiate 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 subdural hemorrhage capsule consists of connective tissue fibers and newly formed vessels.
• The volume of such a hematoma can increase with the occurrence of new injuries. On average, it is about 100 ml.

In chronic subdural hematoma, 25% of people do not remember the injury that caused it (mostly elderly people). The injury may be mild, and after some time (weeks, months) the following occurs:

• headache, the nature of which may change with a change in body position,
• inhibition,
• disturbance of consciousness,
• personality change,
• epileptic seizures.

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

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

Treatment of such hematomas is mainly surgical.

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Brain hematoma in newborns

Hematoma of the brain in newborns occurs due to:

• birth trauma,
• intrauterine hypoxia (oxygen starvation), the consequence of which is severe hemodynamic disturbances,
• disorders of the blood coagulation system.

The clinical picture of intracranial hemorrhage in newborns differs from the symptoms of adults. In a newborn, intracranial hematoma may manifest itself only as anemia against the background of increased intracranial pressure.

Signs of increased intracranial pressure in a newborn:

• anxiety;
• frequent regurgitation not associated with food intake;
• tension of the large fontanelle and its bulging;
• change of cry.

A sudden and progressive deterioration in the newborn's condition or a stable severe condition, accompanied by periods of agitation and depression, should be a reason to worry about the presence of an intracerebral hematoma. This requires a thorough examination by specialists (neurologist, pediatrician, neurosurgeon) and a CT scan of the brain. If the presence of an intracerebral hematoma is confirmed, it is removed.

Another type of hematoma in newborns is cephalohematoma. Cephalohematoma occurs as a result of trauma to the skull bones during childbirth. It is a hemorrhage between the flat bones of the skull and the periosteum (connective tissue). Cephalohematoma is mainly located in the parietal areas. It gradually increases in the first two to three days of life. The size of a cephalohematoma can be from five to 140 ml.

• If the cephalohematoma is small, it will gradually resolve on its own (within two to four weeks).
• If the cephalohematoma is large or takes a long time to resolve, then it is removed, since it can be complicated by suppuration, calcification, and anemia.

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Complications and consequences

The consequences of a brain hematoma are very diverse, everything depends on the degree of damage, the location of the hematoma, its size and the timeliness of medical care. They can be both very severe and mild. In mild and moderate cases of brain hematomas, recovery and full restoration of body functions occur.

In severe conditions, the following consequences of a hematoma may be observed.

1. Chronic fatigue syndrome (asthenia), depression, sleep disorders.
2. Cognitive disorders: memory problems (forgetfulness, difficulty remembering new material), there may be a disorder of thinking, deterioration of mental activity, possible impairment of the ability to acquire and assimilate new information.
3. Speech disorders can be: difficulty speaking and understanding speech, difficulties reading, writing and counting (left-hemispheric brain damage).
4. There may be movement disorders, weakness in the limbs, complete or partial paralysis, and possible impaired coordination of movements.
5. Perceptual disorders, for example, when a person with excellent vision does not understand what he sees, i.e. cannot reproduce what he saw.
6. Behavior may change: tearfulness, the emergence of unmotivated aggression or fear, irritability, emotional lability (instability) - laughter can suddenly change to crying and vice versa.
7. Post-traumatic seizures (epilepsy) are possible.
8. Disorders of urination and defecation (retention or incontinence of urine, feces).
9. Difficulty swallowing and frequent choking may occur.

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Consequences of hematomas in newborns

The consequences of hematomas in newborns can be favorable and end in complete recovery, or they can be unfavorable.

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

• Delay in mental and physical development.
• The development of motor skills occurs with a delay.
• Hydrocephalus may develop.
• Cerebral palsy.
• Impaired coordination of movements.
• Epeleptiform seizures.
• Mental disorders.

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Diagnostics brain hematomas

Diagnosis of a brain hematoma is based on anamnesis (medical history), clinical symptoms and additional examination methods. Since brain hemorrhages are life-threatening, they often require specialized medical care.

Therefore, in the presence of a head injury accompanied by loss of consciousness and other symptoms of hemorrhage, it is necessary to urgently contact a specialist (neurosurgeon, neurologist). In case of suspicion of a brain hematoma, in order to determine its location, size and intracranial pressure, the following is performed:

• Computed tomography (CT) is a tomographic examination using X-rays;
• Magnetic resonance imaging (MRI) is a modern test that uses a magnetic field and radio waves to create images of tissues and organs on a computer monitor.
• Echoencephalography (EEG) – ultrasound is used for diagnostics.
• Cerebral angiography and angiography of spinal cord vessels.
• If necessary, a lumbar puncture is performed, especially in the presence of a spinal cord hematoma.

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Treatment brain hematomas

Treatment of brain hematoma is often surgical, less often conservative. Conservative therapy is carried out if the hematoma is small and does not threaten life, as well as after surgery.

In any case, with a brain hematoma, bed rest is necessary. Conservative therapy for a brain hematoma is aimed at preserving and supporting vital functions of the body. Symptomatic therapy is carried out.

• For severe headaches, analgesics (analgin, ketanov) are prescribed.
• If vomiting occurs, antiemetics - cerucal (metoclopramide).
• In case of severe excitement, neuroleptics and tranquilizers (phenazepam, diazepam) are used.
• In case of respiratory depression, artificial ventilation of the lungs (ALV) is performed.
• Mannitol is prescribed to reduce cerebral edema.
• To prevent recurrent bleeding, antifibrinolytic therapy is prescribed - contrical, vikasol, aminocaproic acid.
• To prevent vascular spasm, calcium channel blockers are prescribed - phenigidine, vitamin E, corticosteroids.
• To improve microcirculation and blood properties, heparin and pentoxifylline are administered.
• During the recovery period, nootropic drugs are prescribed - piracetam, aminolone.
• B vitamins and multivitamins (multitabs, multifort).

Operation

To determine whether surgery is necessary for a brain hematoma, you need to know:

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

1. In cases of subdural hemorrhage, emergency surgery is often performed.

This may be a bone-plastic or resection trepanation. A trepanation hole is made, through which the dura mater of the brain is visible, bluish in color and may pulsate weakly. It is carefully opened, the blood and its clots are removed using a spatula, isotonic sodium chloride solution and wet cotton swabs. The cause of the bleeding is eliminated, after which the dura mater is sutured (a bone flap is placed and sutured in layers, renewing the integument). In order for blood and tissue fluid to flow out of the wound, a drain is first placed for 24 hours. A subdural hematoma can also be removed endoscopically, through a small hole.

If the subdural hematoma is small and the patient feels well, then under the control of MRI or CT, surgery can be avoided. Usually, hematomas of this size resolve within a month under the influence of conservative therapy.

2. Epidural hemorrhage usually also requires emergency surgery. This type of bleeding is the most dangerous due to arterial bleeding.

In the case of a very active process (clinical symptoms of brain compression increase), a burr hole is first made and the hematoma is partially removed, reducing the compression of the brain. Subsequently, bone-plastic trepanation is performed (a bone flap is sawed out), which allows the hematoma to be completely removed and the bleeding to be stopped.

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

Removal of brain hematoma

Removal of a brain hematoma is basically an inevitable method of hematoma therapy. Large brain hematomas that threaten the patient's life are removed. A brain hematoma is removed under general anesthesia by a neurosurgeon. After removal of a brain hematoma, a long period of complex treatment and rehabilitation is required. Timely removal of a brain hematoma increases the patient's chances of recovery.

Treatment of spinal cord hematoma

Treatment of spinal cord hematoma is complex and often conservative.

1. Complete bed rest.
2. To stop bleeding, the following are prescribed: aminocaproic acid, vikasol (coagulants - increase blood clotting).
3. If urination is impaired (retention), bladder catheterization is indicated.
4. During the recovery period, anticholinesterase drugs (proserin, galantamine) are prescribed - they improve and restore neuromuscular transmission.
5. B vitamins – improve metabolic processes in the cell.
6. Neuroprotectors and nootropic drugs (piracetam, aminalon, cerebrolysin) are prescribed.
7. Antibacterial agents are often prescribed for spinal cord hematomas to prevent the development of secondary infections (cystitis, pyelonephritis, pneumonia) – ceftriaxone, sumamed.
8. During the recovery period – therapeutic exercise, massages.

Prevention

Prevention of brain hematoma consists of the following.

1. Avoid brain injuries (do not participate in fights, avoid traumatic sports, drive carefully, etc.).
2. Do not abuse alcohol.
3. Do not use medications (eg aspirin) without supervision.
4. Treat concomitant diseases: eliminate high blood pressure, prevent the development of anemia – eat well and rationally.
5. If a brain injury does occur, it is necessary to seek help from a specialist (neurologist, neurosurgeon) as soon as possible.
6. Undergo regular preventive examinations and a comprehensive examination of the entire body, at least once a year.

Prevention of brain hematomas in newborns.

• Timely identification and treatment of pathological conditions in the pregnant woman and fetus.
• Competent management of childbirth.

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Forecast

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

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