How does acute and subacute intracerebral hematoma do?

summary

Acute and subacute intracerebral hematomas are traumatic intracerebral hematomas. Most of them are acute, and a few are subacute, especially the superficial intracerebral hematomas located in the frontal, anterior temporal and bottom, which are often accompanied by brain contusion and laceration and subdural hematoma. The deep hematoma was more than that in the white matter, which was caused by the deep blood vessel tearing and bleeding caused by the brain deformation or shear force; Less bleeding, small hematoma and slow clinical manifestation. When the hematoma is large, the hematoma located near the basal ganglia, thalamus or ventricular wall can break into the ventricle and cause intraventricular hemorrhage.

How does acute and subacute intracerebral hematoma do?

Traumatic intracerebral hematoma usually occurs in frontal lobe and temporal lobe, which is often caused by contrecoup brain contusion; The second is the parietal lobe and occipital lobe, which are caused by direct impact injury or depressed fracture. The rest are intracerebral hematomas in deep brain, brain stem and cerebellum. In addition, due to the increase of vascular fragility in the elderly, intracerebral hematoma is more likely to occur.

Most of traumatic intracerebral hematomas are acute, and a few are subacute. The clinical manifestation of intracerebral hematoma depends on the location of hematoma. Hematomas located in the front and bottom of frontal and temporal regions are similar to contrecoup brain contusion and laceration and subdural hematoma. Except for increased intracranial pressure, most of them have no obvious localized symptoms or signs. If the hematoma involved the important functional areas, signs such as hemiplegia, aphasia, hemiblindness, hemiparesthesia and focal epilepsy may appear. Patients with intracerebral hematoma caused by contrecoup brain contusion and laceration often have persistent disturbance of consciousness and progressive aggravation after injury, and their condition changes quickly, which is easy to cause cerebral hernia. Local hematoma caused by impact injury or depressed fracture, with slow development of the disease, in addition to the symptoms of local brain function damage, patients often have headache, vomiting, fundus edema and other signs of increased intracranial pressure.

The treatment of acute subdural hematoma is the same as that of acute subdural hematoma. After the removal of subdural hematoma, the frontal and temporal lobe intracerebral hematoma should be explored immediately. If there is no obvious relief of intracranial pressure after evacuation of hematoma, or there are other suspicious places, such as contusion on the surface of brain, enlargement of gyrus, and fluctuation, puncture should be performed. For those with suspected ventricular perforation, intraventricular puncture and drainage should be performed. If necessary, intraoperative brain ultrasound detection should be used to exclude deep brain hematoma.

matters needing attention

For subacute patients with slow development, the increase of intracranial pressure should be considered. If it is progressive and there is a tendency to form cerebral hernia, surgical treatment is still appropriate. As for the operation method is to use craniotomy or drilling irrigation and drainage, it should be based on the number of liquid part of the hematoma, if the solid component is more, it should be completely removed by surgical incision.