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All Posts Tagged: Trepanation

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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