Treatments for acute subdural hematoma

This is an automatically translated article.

Acute subdural hematoma is a hematoma that forms under the dura within 72 hours of injury. Treatment of acute subdural hematoma requires aggressive, sometimes urgent surgery because the disease has a high mortality rate and can leave severe sequelae.

1. Definition of acute subdural hematoma

Subdural hematoma is a condition in which a blood vessel in the subdural space ruptures causing a hematoma to form in the subdural space - the space between the dura mater and the arachnoid membrane, usually after a traumatic brain injury.
A subdural hematoma is called acute when the hematoma forms rapidly immediately or within a few hours of the injury, usually within 72 hours.

2. Causes of acute subdural hematoma

Acute subdural hematoma is severe traumatic brain injury caused by rupture of the superficial or pontine veins in the cerebral cortex or the lateral wall of the venous sinuses.
Causes of acute subdural hematoma include:
Traumatic brain injury. This is the most common cause. Brain atrophy stretches blood vessels and increases the risk of bleeding even with very minor trauma. Coagulation disorders that cause spontaneous subdural bleeding such as anticoagulants (vitamin K antagonists, antiplatelet agents), hemophilia (haemophilia A, haemophilia B), thrombocytopenia. Cerebral aneurysm, cerebrovascular malformation. Meningiomas cause bleeding. Complications from neurosurgery.

3. Symptoms of subdural hematoma

Acute subdural hematoma often presents with symptoms soon after trauma. The severity of symptoms depends on the duration, rate of bleeding, and size of the hematoma.
Consciousness disturbances: Struggling, excited, comatose. The patient may be comatose at the time of injury or have a gradual decline in consciousness and coma after a period of awakening. If the large hematoma compresses the brain parenchyma, there will be signs of increased intracranial pressure such as headache, vomiting, dilated magnetic fields, stiff neck, even convulsions. Localized neurological signs such as paralysis of the limbs on one side of the body, paralysis of the cranial nerves. Dilated pupils on the same side of the lesion or on the opposite side of the lesion if the brain stem is displaced from the opposite side. Autonomic signs such as bradycardia, increased blood pressure, breathing disturbances, and temperature disturbances.

4. Diagnosis of subdural hematoma

In addition to clinical symptoms, the diagnosis of acute subdural hematoma is also based on clinical examination.
Blood tests to count platelets, tests for coagulation function, quantification of clotting factors if hematologic disease is suspected. Computed tomography of the brain is the best imaging test available today for the location of the hematoma and associated lesions. Acute subdural hematoma presents as a crescent-shaped mass, bleeding across the skull joints, and pericortical hyperattenuation. Brain magnetic resonance imaging is more sensitive in detecting intracerebral hemorrhage, small subdural hematoma, and subdural hematoma in the interhemispheric cleft or tentacle of the cerebellum. Cerebral angiography is indicated when the cause of acute subdural hematoma cannot be found by CT scan or brain MRI. Cerebral angiography can detect vascular malformations, aneurysms, and wall lesions.

5. Treatment methods for acute subdural hematoma

Treatment of an acute subdural hematoma depends on the rate of hematoma formation, the size of the hematoma, and the clinical symptoms.
If the subdural hematoma is acute but the hematoma is small, asymptomatic, or asymptomatic, sometimes the patient only needs medical treatment for symptoms and careful monitoring. Because the body will secrete substances that dissolve blood clots. Medical treatment should be initiated immediately after the accident and maintained immediately as well as after surgery. The goal of medical treatment is to prevent brain damage secondary to a hematoma or increased intracranial pressure.

If new signs start to appear, condition worsens, or CT scan shows an increased hematoma, surgery may be needed. Indications for surgery for acute subdural hematoma are as follows:
Acute subdural hematoma has a clear interval. Subdural hematoma causes midline displacement > 5 mm or hematoma size > 10 mm. The subdural hematoma has worsening consciousness, based on the Glasgow coma scale down 2 points from baseline, with the hematoma on the CT scan - Brain scan showing an enlarged lesion requiring decompression surgery. Subdural hematoma with progressive pupillary dilation, asymmetric dilation, progressive focal neurologic signs. A subdural hematoma that causes elevated intracranial pressure (above 20 mmHg) requires early surgery. Surgical methods include drilling a hole in the skull or opening the skull cap to decompress.
Skull hole drilling is the process of making a small hole on the site of a hematoma formed by drilling through the skull. Through these small holes, the hematoma can be taken or sucked out. The incision will be closed with sutures or skin clamps. Craniotomy Decompression is the process of exposing the brain and meninges by cutting off part of the skull. This method helps reduce pressure inside the skull and opens the way to remove the hematoma. The cut part of the skull is then repositioned and fixed in place. A subdural hematoma is a serious illness and requires emergency treatment. CT scan may show subdural hematoma.
Vinmec International General Hospital is proud to be one of the general hospital systems that have invested in modern CT scanners with a team of doctors who are top experts who can conduct imaging, diagnose, detect pathologies of brain damage, and at the same time find out the causes of the disease, thereby directing examination, treatment and rehabilitation for patients.

Please dial HOTLINE for more information or register for an appointment HERE. Download MyVinmec app to make appointments faster and to manage your bookings easily.

Reference sources: benhviendktinhquangninh.vn, bvngoaithantinhqt.org.vn, Thaythuocvietnam.vn