HEAD INJURY, SUBDURAL HEMORRHAGE & HEMATOMA |
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General Information
DEFINITION--Bleeding (hemorrhage) that causes blood to collect and clot (hematoma) beneath the membranes (meninges) that cover the brain. There are 2 types of subdural hematomas:
An acute subdural hematoma occurs soon after a severe head injury. It is the most frequent cause of death from injury in contact sports.
A chronic subdural hematoma may develop weeks after a head injury. The injury may have been so minor that the patient does not remember it.
BODY PARTS INVOLVED
Brain.
Meninges.
Blood vessels to the brain.
Skull.
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SIGNS & SYMPTOMS
Recurrent, worsening headaches.
Fluctuating drowsiness, dizziness, mental changes or confusion.
Weakness or numbness on one side of the body.
Vision disturbances.
Vomiting without nausea.
Pupils of different size (sometimes).
CAUSES
Acute: Severe blow to the head that bruises and tears the brain and its blood vessels.
Chronic: Minor (even forgotten) head injury. Blood in the enclosed space in the brain forms a hematoma that gradually increases with further bleeding.
RISK INCREASES WITH
Contact sports such as boxing, football or hockey.
Auto, motorcycle or bike racing.
During surgery, surgical risk increases with smoking and use of drugs, including anticoagulants, muscle relaxants, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers, corticosteroids or mind-altering drugs.
HOW TO PREVENTWear a protective helmet for any activity at risk for a head injury.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's diagnosis.
Surgery to remove the clot causing pressure on the brain.
Physical therapy for rehabilitation if there is any residual paralysis or other disability.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and physical exam by a doctor.
Laboratory studies of blood and cerebrospinal fluid.
Hospital diagnostic tests such as X-rays, arteriography, radioactive uptake studies and CAT scan (See Glossary for all).
POSSIBLE COMPLICATIONS
Death or permanent brain damage, including partial or complete paralysis, behavioral and personality changes, and speech problems.
Convulsions following surgery.
PROBABLE OUTCOMEThe degree of recovery depends upon general health, age, severity of the injury, rapidity of the treatment and extensiveness of the bleeding or clot. After the clot is removed, brain tissue that has been compressed usually expands slowly to fill its original space. If speech or muscle control has been damaged, physical therapy or speech therapy may be necessary. The outlook for complete recovery is good with quick diagnosis and prompt surgery.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDAfter any head injury:
If the victim is wearing headgear with a face guard, cut the face guard off but DON'T REMOVE THE HEADGEAR OR MOVE THE HEAD OR NECK FOR ANY REASON. Brain injury is frequently associated with neck injury.
If the victim vomits, support the head and neck completely and carefully while rotating the entire body to the side to prevent aspiration.
Splint the head and neck and transport the person to the nearest well-equipped emergency facility.
Elevate the head of the stretcher slightly. Do not use pillows.
Watch closely for vomiting, convulsions, changes in consciousness, paralysis or impaired breathing. Be ready to render CPR if needed.
CONTINUING CARESurgery is the only treatment for a subdural hemorrhage and hematoma. Under local or light general anesthesia, small holes are bored through the skull. The blood clot (which looks like currant jelly) is removed manually or by suction. After surgery, symptoms usually improve rapidly.
MEDICATIONYour doctor may prescribe:
Corticosteroid drugs to reduce swelling inside the skull.
Anticonvulsant medication.
Antibiotics to fight infection.
ACTIVITYAfter surgery, stay as active as your strength allows. Work and exercise moderately, and rest often. Once you have had a subdural hemorrhage, don't participate in contact sports.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONConsult your doctor or a physical therapist.
CALL YOUR DOCTOR IF
You have had a head injury--even if it seems minor--and you develop any symptoms of a subdural hemorrhage. This is an emergency!
The following occurs during or after surgery:
Temperature rises to 101F (38.3C) or higher.
Surgical wound becomes red, swollen or tender.
Headache worsens.
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