Intracerebral hematoma - Causes, Symptoms, Diagnosis and Treatment
Intracerebral hematoma - A limited accumulation of blood in the brain matter, rendering compressive biasing and damaging effect on the brain tissue located near. Intracerebral hematoma is clinically characterized by cerebral and focal symptoms, which depend on the location of the hematoma and its volume. Most significantly intracerebral hematoma diagnosed by combined use of CT and MRI of the brain, as well as angiographic studies of the brain vessels. Mostly intracerebral hematoma can be treated conservatively, a large intracerebral hematoma - only surgically, by removing or aspiration.
Intracerebral hematoma
hematoma blood. The amount of blood that can accommodate intracerebral hematoma, ranges from 1 to 100 ml. Increasing the size of intracerebral hematoma occurs, usually within 2-3 hours after the onset of bleeding and clotting in violation longer.
The resulting intracerebral hematoma compresses the surrounding brain tissue, resulting in damage and necrosis. Along with this, intracerebral hematoma causes increased intracranial pressure and can lead to brain edema. Intracerebral hematoma considerable size can lead to a shift of brain structures and the development of so-called dislocation syndrome. Moreover, bleeding leads to reflex spasm, and cerebrovascular ischemia, primarily in the areas located near hematoma. Ischemia is a further damaging factor leading to pathological changes spread far beyond the formed hematoma. Around 14% of cases intracerebral hematoma breaks in the ventricles of the brain, leading to hemorrhage into the ventricles. According to some sources in 23% of cases of intracerebral hematoma combined with the formation of the cerebral membranes subdural, epidural or epi-subdural hematoma.
traumatic brain injury or post-traumatic bleeding in diapedetic contusion foci. Formation intracerebral hematoma possible to break a brain aneurysm or arteriovenous malformation, resulting arrosive bleeding intracerebral tumors, due to hemorrhagic stroke due to excessive increase in intravascular pressure in hypertension and /or disorders of the vascular wall elasticity atherosclerosis, systemic vasculitis, diabetic macroangiopathy and others. Intracerebral hematoma may be associated with changes in blood realogicheskih properties in hemophilia, leukemia, liver disease (chronic hepatitis, cirrhosis), treatment with anticoagulants, and so on. n.
neurology uses several classifications of intracerebral hematoma, which give an idea of their different characteristics: location, size, etiology. Depending on the location of the center is isolated, subcortical and cortical-subcortical intracerebral hematoma and hematoma of the cerebellum. There are lobar, medial, lateral, and mixed intracerebral hematoma. The size of intracerebral hematoma can be classified as small (up to 20 ml, CT diameter of not more than 3 cm), medium (20-50 ml, CT diameter 3-4.5 cm) and large (> 50 ml, CT diameter> 4.5 cm).
Due to the occurrence of intracerebral hematoma can be posttraumatic, hypertensive, aneurysms, tumors and so forth. For post-traumatic hematoma in traumatology used classification since its inception. Primary intracerebral hematoma formed immediately after the TBI, delayed intracerebral hematoma - a day or more.
dizziness, severe headache, nausea and vomiting. More than half of the cases of intracerebral hematoma is characterized by impaired consciousness from sopor to coma. Sometimes the oppression of consciousness preceded by a period of psychomotor agitation. Intracerebral hematoma formation may occur with the presence of an erased interval of light in the patient's condition, a light with a longer gap or without it.
Alopecia symptomatic intracerebral hematoma depends on the volume and localization. So, there is a more pronounced neurological deficit with small hematomas in the area of the internal capsule, than the much larger hematomas localized in less significant in terms of functional areas of the brain. Most often intracerebral hematoma accompanied by hemiparesis, aphasia (speech disorder), sensory impairment, no tendon reflexes symmetrical right and left limbs, convulsive epileptic seizures. There may be anisocoria, hemianopsia, frontal symptoms: upset the critics and memory, behavioral disorders.
Substantial intracerebral hematoma quickly leads to dislocation syndrome resulting from the displacement of brain structures. Causing an increase in the volume of the contents of the skull, intracerebral hematoma leads to a shift of brain structures in the caudal direction and herniation of the cerebellar tonsils into the foramen magnum. The result is a compression of the medulla oblongata, clinically manifested symptoms stem: nystagmus, impaired swallowing (dysphagia), a disorder of the respiratory rhythm, diplopia, hearing loss, vestibular ataxia, hypo-or anosmia, strabismus and ptosis of the upper eyelid, bradycardia, pyrexia and blood pressure rise.
Intracerebral hematoma breakthrough blood into the ventricles is characterized by hyperthermia, rapidly developing depression consciousness up to coma, the presence of meningeal symptoms, convulsions gormetonicheskimi - paroxysmal increased tone of muscles, in which the hands are bent and are given to the body and legs as much as possible unfolded.
Intracerebral hematoma delayed nature of clinically manifest lack of improvement in the patient's condition, or a sharp deterioration in his condition after a day or more after the injury.
CT of the brain. As a rule, tomograms intracerebral hematoma looks hearth homogeneous density of round or oval. If the hematoma has formed as a result of a brain injury, it usually has an uneven contour. Over time there is a reduction of density to hematoma lsodensity state where its density corresponds to the density of the brain tissue. For small hematomas that period is 2-3 weeks, but for the medium - to 5 weeks. With a decrease in the density of hematoma better visualized using MRI of the brain, although in the initial period of the use of MRI may lead to misdiagnosis in favor of tumor hemorrhage. Therefore, subject to availability, and many neurologists, neurosurgeons prefer to use in the diagnosis of both methods of imaging (CT and MRI).
In order to identify vascular disorders caused by reflex vasoconstriction, as well as for the diagnosis of aneurysms and arteriovenous malformations of the brain is used angiography or magnetic resonance angiography (MRA). Self-employed in the diagnosis of intracerebral hematoma angiography can not, because it does not make it possible to accurately differentiate the site of brain injury from bruising.
Differentiate intracerebral hematoma should be a hemispheric tumor, a hotbed of the brain injury, ischemic stroke, brush and brain abscess.
thromboembolism, blood pressure correction. To reduce intracranial pressure under the control of the electrolyte composition of blood used diuretics.
The large diameter of intracerebral hematoma, severe focal symptoms, altered mental status is an indication for surgical treatment. The presence of signs of compression of the brain stem and /or dislocation syndrome is cause for urgent surgery. Operation of choice is the transcranial removal of a hematoma. Less traumatic method of surgical treatment of intracerebral hematoma is an endoscopic evacuation. With regard to small hematomas accompanied by a significant neurological deficit, stereotactic aspiration can be used.
When removing multiple hematomas often subject to only the largest of them. If intracerebral hematoma hematoma combined with shells of the same hemisphere, its removal is carried out in conjunction with the removal of the subdural hematoma. If intracerebral hematoma small or medium-sized localized on the other side of the hematoma membranes, it can not be removed.
obesity, hypertension, diabetes, and others.), the degree and duration of impairment of consciousness, with the combination of intracerebral hematoma hematomas shells, timeliness and adequacy of medical care. The most unfavorable outlook for bruises, breaks through into the brain ventricles. The main causes of death - a swelling of the brain and dislocation. About 10-15% of patients with hemorrhagic stroke die from hemorrhage recurrence, and about 70% have persistent disabling neurological deficit.