How does child chronic subdural hematoma return a responsibility?
summary
Subdural hematoma refers to the subdural hemorrhage caused by trauma or coagulation dysfunction, the accumulation of blood in the space between the arachnoid and dura, resulting in brain injury. According to the clinical symptoms, it can be divided into acute, subacute and chronic subdural hematoma. Chronic subdural hematoma is a kind of hematoma that has formed a capsule and appears more than 3 weeks after head trauma. The vast majority of hematomas come from slight and neglected head injuries, which are often caused by birth injuries in children. Chronic subdural hematoma in children is mostly bilateral, and the bleeding mostly comes from the rupture of the bridging vein which flows into the superior sagittal sinus on the surface of the brain. The bleeding pressure is low and the formation of hematoma is slow, which usually does not cause the rapid increase of intracranial pressure. How does child chronic subdural hematoma return a responsibility?
How does child chronic subdural hematoma return a responsibility?
The main signs were chronic brain compression and focal nerve localization. The patient's condition progressed slowly and gradually appeared the symptoms of chronic intracranial hypertension. About 60% of children show progressive enlargement of head circumference, swelling of anterior fontanel, vomiting, irritability or drowsiness. Older children may have headache, dizziness, inattention, memory loss or vision loss. Fundus examination often shows optic disc edema or retinal hemorrhage. For the chronic subdural hematoma with cranial enlargement, vomiting and anterior fontanelle swelling, we should pay attention to distinguish it from congenital hydrocephalus, but the degree of cranial enlargement of the former is not as good as that of the latter, and the percussion in the parietooccipital region of children with hydrocephalus often appears drum sound or broken pot sound, the percussion in the chronic subdural hematoma area is often blunt solid sound, and the bone suture separation is more obvious in children with congenital hydrocephalus. About 40% of the children had focal nerve damage signs due to cortical compression, such as hemiplegia, hemiplegia or pyramidal tract sign, central facial paralysis or aphasia; The cortical stimulation of adhesive calcified capsule can induce epilepsy.
The possibility of chronic subdural hematoma should be considered when the patient is less than 6 months old, has a history of slight trauma or birth injury, gradually presents symptoms of increased head circumference and chronic intracranial pressure after a period of time, and is accompanied by signs of focal neurological impairment. CT scan should be done in combination with medical history. For highly suspected children, diagnostic puncture is also feasible. There are a large number of old brown or brown liquid outflow, so the diagnosis can be clear.
The clinical manifestations of patients with subdural hematoma of different ages may have their own characteristics. Due to the compression of hematoma in young and middle-aged people, cerebral venous reflux is obstructed, resulting in brain edema and intracranial hypertension. In elderly patients, the intracranial space is relatively enlarged due to brain atrophy, and the symptoms of intracranial hypertension are relatively mild. Patients with arteriosclerosis are prone to neurological and psychiatric symptoms.
matters needing attention
Pay attention to perinatal health care to prevent premature birth and dystocia; Improve delivery technology to prevent neonatal brain injury; Take good care of children of all ages to prevent brain injury; Vitamin K was supplemented routinely after birth to prevent spontaneous hemorrhage caused by vitamin K deficiency. Eat more foods with high protein, vitamins and trace elements.
