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All Posts in Category: Traumatic brain injury (TBI)

Intracerebral hematoma (contusion)

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Post-traumatic intracerebral hematoma occurs following TBI. It may not be accompanied by a skull fracture. Its diagnosis is made by CT. Clinically, the patient presents with neurological symptoms such as disturbances of the level of consciousness, peritraumatic amnesia, disorientation, agitation, drowsiness, weakness of one side of the body, and other symptoms. If the contusion is limited and the neurological image is good, no surgery is required, only hospitalization for a few days and a repeat CT scan. However, if the symptoms are severe or worsen, surgical removal of the hematoma is required to decompress the brain. Permanent removal of part of the skull bone may be required to create enough space in the brain and to treat cerebral edema (swelling of the brain). Sometimes fractures are fatal despite surgery, or they may leave the patient with severe permanent disability.

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Skull fractures

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Skull fractures occur following a head injury and are diagnosed by a simple skull x-ray. Following that, a cerebral CT scan should always be performed, in order to rule out the coexistence of hematoma under the skull, which can put pressure on the brain and be life-threatening for the patient. If there is no hematoma, surgery is not required unless the fracture has displaced the bone inside the skull, exerting pressing on the brain (depressed cranial fructure). Therefore, the depressed cranial fracgture is restored with surgery, unless it is very small. If the head injury in the fracture area is open, then the fracture is called complicated and it requires surgical treatment to remove any foreign bodies to prevent infection. The patient is hospitalized for a few days in order for the patient’s neurological image to be monitored. In simple fractures, 1-2 days of hospitalization are enough for simple follow-up.

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Epidural hematoma

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This is a hematoma that forms under the bones of the skull, including the meninges of the brain. These hematomas usually occur following a fracture of the skull bones and are usually due to bleeding of the arteries running between the meninges and the bone, in the fracture area. The diagnosis is made by cerebral CT. It is more common in young people. If not diagnosed and operated on immediately, this can be fatal. The symptoms include severe headache, vomiting, drowsiness, loss of consciousness, neurological deficit (weakness of one side of the body), and after their onset, symptoms usually progress rapidly. If diagnosed early, symptoms are relieved via a simple craniotomy, which has a very good prognosis.

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Acute subdural hematoma

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Unlike the chronic subdural hematoma, acute subdural hematoma is a very severe condition with approx. 50% mortality. It is commonly seen in severe traumatic brain injuries and may coexist with other lesions, such as epidural hematoma and intracerebral hemorrhage. Clinically the patient’s neurological picture is poor, and if the hematoma is not removed, the patient rapidly progresses. In some cases, if the hematoma is small, does not cause displacement of the brain and the neurological image is good, the patient can be monitored in the hospital, having a clinical evaluation of his neurological clinical image and a repeat CT in a few days to see if the hematoma is absorbed. In such cases, it may develop into chronic hematoma.
Surgery, when required, removes the hematoma and usually one or more injured veins are identified in the area between the meninges and the brain. After surgery, the patient may be required to remain in the intensive care unit to treat and prevent possible cerebral edema and ischemia. Older people have a worse prognosis, and use of anticoagulants before the injury has a negative effect on the prognosis. Many of the surviving patients present with severe disabilities, and their recovery process is long and painstaking.

 

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Chronic subdural hematoma

 

 

Chronic subdural hematoma is a collection of bloody fluid between the meninges and the brain. It may occur following a head injury and can even occur 1-2 months after the blow. It is most commonly seen in the elderly, and chronic anticoagulant therapy (incl. aspirin) appears to increase its incidence. Clinically, the patient presents with headache, gradual onset of gait instability, confusion, agitation, or weakness on one side of the body. There may also be drowsiness and lethargy. The patient’s history usually includes a blow to the head, which may not have been particularly severe. The diagnosis is made by CT. If it causes symptoms, it must be surgically removed. Usually 2 cranial trepanations are made (small holes in the skull measuring one centimeter in diameter) and the fluid is removed, decompressing the brain. The operation can be performed even with local anesthesia, in selected patients. Repeated removal of the fluid may be required, as recurrence is not uncommon. Sometimes the hematoma is small and does not require surgical removal; CT follow-up is required. Administration of medication (cortisone) may be required. This is a benign condition that usually has a good outcome.

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Rehabilitation

 

What is rehabilitation?

Rehabilitation is a process that requires the cooperation of physicians with different specialties, in order to restore the patient’s skills and help the patient’s family to adapt and help them cope with the consequences of their condition. The main idea for rehabilitation needs to be a rational approach to the improvements that can be achieved.

The family

The family is an integral part for rehabilitation. The stress and pressure put on the family is significant, because the outcome, the duration of recovery, and the severity of the condition are all uncertain. However, there are special programs and centers that can help the patient suffering from traumatic brain injury along with their family.
Family members need to learn to walk like a marathon runner. When the risk to the patient’s life is over, a return to a daily routine is encouraged so that family activities are maintained to the best extent possible, and used for the benefit of the patient throughout recovery.

Family and friends need to be well informed in order to cope with the problem and help the patient. There are many sources of information, including the treating physician, the nursing staff, and rehabilitation centers. Information contributes to a better understanding of this condition. Understanding is essential to making the right decisions, in order to offer the best possible care to the patient.

At the hospital

Rehabilitation begins in the hospital, with the team treating the trauma patient as an acute case (neurosurgeon, nursing staff, physical therapists, occupational therapists, speech therapists, social workers). Once the patient’s condition is stable, the patient can then be transferred to a rehabilitation center, where psychiatrists, neuropsychologists, and rehabilitation specialists continue to coordinate the rehabilitation effort.

After getting discharged from the hospital

After getting discharged from the hospital If specialized nursing care is needed, then a special infrastructure may be needed. The level of care and intensification of rehabilitation is based on the patient’s level of functionality, recovery progress, return, and availability. We should keep in mind that rehabilitation does not cause recovery, but offers the possibility for the patient to recover.

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