In general commonest hemorrhage following head injury is
SUBDURAL HAEMATOMA Types Acute Chronic Acute Subdural Haematoma It is a collection of blood between the brain and dura. It is due to injury to the coical veins and often due to laceration of coex of brain which bleeds and blood gets collected in the subdural space forming a haematoma. Here haematoma is extensive and diffuse. There is no lucid interval. There is severe primary brain damage. Haematoma may be of coup and contre-coup type. Loss of consciousness occurs immediately after trauma and Is progressive. Convulsion is common. Features of raised intracranial pressure is obviously seen high BP, bradycardia, vomiting. Focal neurological deficits or hemiparesis can occur. CT scan shows concavo-convex lesion. Treatment Antibiotics, anticonvulsants. Surgical decompression is done by craniotomy. Chronic Subdural Haematoma It is due to the rupture of veins between dura and brain (cerebral hemispheres), causing gradual collection of blood in subdural space. It is commonly seen in elderly people following any minor trauma like fall, slipping (which might have gone unnoticed). In elderly people, brain atrophies and even minor injuries can cause shearing and bleeding from these veins. Blood collects gradually over 2-6 weeks. Plasma and cellular components get separated. Eventually cellular pa gets absorbed leaving only fluid component. It is called as chronic subdural hygroma. Usual haematoma collection is 60-120 ml. Often in 50% of cases, it is bilateral. Clinical Features Common in old age, with history of minor trauma. Patient presents with confusion, disorientation, gradually with altered level of consciousness and drowsiness. Later convulsions, features of intracranial hypeension, features of coning develops. Extensor plantar response and pupillary changes develop eventually. Investigations CT scan (shows concavo-convex lesion). Serum electrolytes. Blood grouping and cross matching. Differential Diagnosis Electrolyte imbalance. Intracranial space occupying lesion. Treatment Craniotomy and evacuation of clot is done when required on both sides. Antibiotics. Anticonvulsants for 3 years. Complications Epilepsy Meningitis Coning Neurological deficits Ref: SRB's Manual of Surgery 5th edition Pgno : 1096
Subcoical
Extradural
Subdural
Intraventricular
Trauma