After 4 weeks of Head trauma, pt. presents with features of irritability and altered sensorium. Commonest cause will be ?
Ans. is 'a' Chronic subdural hematoma Chronic subdural hematoma is a type of traumatic intracranial heamorrhage. Traumatic Intracranial haemorrhage is of two types ? 1. Acute extradural hematoma & 2. Chronic subdural hematoma Acute Extradural hematoma Accumulation of blood b/w skull & dura Bleeding is from a branch of middle meningeal aery* in 90% of cases. Trauma is usually severe associated with concussion and skull fracture. With aerial bleeding, the hematoma expands rapidly, and symptoms appear within hours after injury. The clinical course is acute ? After a head injury often associated with a variable period of concussion - the patient appears normal for several hours (lucid interval). After this lucid interval, the pt. develops evidence of increased intracranial pressure with headache, vomitting, altered consciousness, and papilledema. Tentorial herniation rapidly follows, with occulomotor nerve palsy (pupillary inequality appears first, followed by failure of reaction to light k/a Hutchinson's sign and pyramidal tract compression. Compression of the brain stem follows, resulting in changes in hea rate, blood pressure and respiration. Coma and death rapidly ensue in untreated cases. Its an emergency and requires prompt diagnosis & surgical evacuation of the extradural blood collection. Chronic Subdural hematoma Accumalation of blood in the subdural space It occurs mainly in elderly patients with some degree of cerebral atrophy. The amount of trauma required is minimal. Bleeding is the result of rupture of communicating veins passing from the cerebral coex to the superior saggital sinus. Rupture occurs when there is movement of the brain relative to the fixed superior saggital sinus and is most likely when cerebral atrophy is present. Clinical course is slow (over days to month). - Pt. presents with slowly increasing intracranial pressure, causing headache, vomitting, papillcdema and fluctuating levels of consciousness. - Compression of the underlying brain may cause focal epileptic convulsions and neurological symptoms, most commonly contralateral spastic paralysis with prolonged but less severe compression, atrophy of the brain occurs and cause dementia. Treatment is by surgical evacuation of the subdural collection.
Chronic subdural hematoma
Extradural hematoma
Intraparenchymal bleed
Electrolyte imbalance