Brief introduction of intracranial hemorrhage

Directory 1 Pinyin 2 Introduction 3 Intracranial Hemorrhage in Newborns 4 Intracranial Hemorrhage in Children 4. 1 Epidural Hematoma 4.2 Subdural Hematoma 4.3 Subarachnoid Hemorrhage 4.4 Intracerebral Hematoma 1 Pinyin lúnèI chüXuè

2 Introduction Intracranial hemorrhage in children can be divided into four types according to different bleeding sites: epidural hematoma, subdural hematoma, subarachnoid hemorrhage and intracerebral hematoma. For example, intracranial hemorrhage in newborns and intracranial hemorrhage in children can be divided according to the bleeding time.

3 Intracranial Hemorrhage of Newborns Most intracranial hemorrhage of Newborns occurs in the process of delivery. There are two reasons for intracranial hemorrhage: ① Hemorrhage caused by hypoxia: such as maternal blood loss, early placental abruption, or premature rupture of umbilical cord around the neck and amniotic membrane, which causes neonatal asphyxia and hypoxia, causes blood circulation disorder of the whole body and brain tissue, leads to venous congestion, increased permeability of blood vessel wall and capillary oozing. Bleeding can occur before, during and after delivery, especially in premature infants. ② Traumatic bleeding: Full-term infants are more common. Common in breech delivery and caesarean section. Intracranial hemorrhage in newborns often involves the whole brain surface and meninges, and extensive hemorrhage in the whole brain parenchyma and ventricles can also occur.

Symptoms such as lethargy, coma and irregular breathing appear immediately after birth; Pale face or paroxysmal cyanosis; Refusing milk, vomiting, irritability, screaming, muscle twitching, fright, syncope, varus cornus or paralysis; The fontanel is full or bulging. At the same time, retinal hemorrhage, ophthalmoplegia, unequal pupil sizes, disappearance of light response and nystagmus can be seen.

During the treatment, the sick child should be quiet, use sedative and hemostatic drugs, and closely observe the condition. If necessary, make a subdural puncture of the anterior fontanel to release bloody liquid. The prognosis of patients with massive hemorrhage is poor, even improved. Many sick children have sequelae such as cerebral palsy, epilepsy or mental retardation.

Intracranial hemorrhage in children is mostly caused by trauma, which can occur in epidural space, subdural space, subarachnoid space or brain parenchyma. Sometimes it accumulates into a huge hematoma, forming a localized space-occupying lesion, and some hematoma can be dissolved and absorbed by itself; Some are scattered in spots and do not cause special symptoms. Bleeding can be divided into the following types according to different parts:

4. 1 Epidural hematoma is mostly located in the tentorium cerebelli. It is usually caused by direct head injury, skull fracture or skull deformation, and dural vascular tear. Hemorrhage mostly comes from venous system, and blood accumulates in epidural space to form hematoma. Local small hematoma can be asymptomatic. Large hematoma covers the whole cerebral hemisphere, and the amount of bleeding can exceed 300ml. About 3/4 of epidural hematoma occurred in the temporal region, and it was rare in other parts.

The course of epidural hematoma in children is slow, because it is more harmful to veins. Older children may have a typical period of intermediate awakening or consciousness improvement. However, the early consciousness of infants and young children is often not lost or just in a short trance.

Aphasia, hemianopia, facial paralysis or hemiplegia may occur due to the compression of brain tissue by hematoma, and Babinski sign is positive.

The symptoms of intracranial hypertension in children are more serious than those in adults. There was a brief coma after the injury. After full recovery of consciousness, intracranial pressure increased rapidly due to intracranial hemorrhage, with persistent headache, dizziness, irritability, frequent vomiting, rapid breathing, rapid pulse and high blood pressure, consciousness gradually blurred and gradually entered a coma. The interval between two comas is about 2-3 hours. If there is cerebral hernia, the pupil of the affected side shrinks first, then expands, the light response weakens, and finally disappears completely. Hemiplegia and pathological reflex appear on the opposite side, pulse is slow, breathing is slow and deep, blood pressure and body temperature are elevated. Without emergency surgery, the contralateral pupil will eventually dilate and die of respiratory failure.

Surgery should be performed to clear the hematoma and stop bleeding completely. Patients with primary brain contusion and brain edema should be treated according to brain contusion and laceration after operation.

4.2 subdural hematoma subdural hematoma is located between dura mater and arachnoid membrane. Clinically, subdural hematoma can be divided into acute and chronic. Symptoms appear immediately after acute subdural hematoma injury; Chronic subdural hematoma showed symptoms 3 weeks after injury. Sources of bleeding: ① The superficial vein of the brain that passes through the subdural cavity and enters the venous sinus is broken. ② Rupture of venous sinus. ③ rupture of large blood vessels on the brain surface. ④ The great cerebral vein (Galen vein) and straight sinus draining the cerebral vein were torn.

The clinical manifestations are similar to epidural hematoma. Acute subdural hematoma is often accompanied by severe brain contusion and laceration, deep coma, serious illness, not obvious in the middle waking period, or some cases appear. The symptoms of cerebral hernia appear later. When combined with severe brain contusion, the bleeding is severe, the brain edema appears quickly, and the intracranial pressure is seriously increased. Often died of rapidly developing respiratory failure. Skull fracture is rare, and the fracture position is inconsistent with the hematoma position. Cerebrospinal fluid pressure increased, blood and protein increased.

Chronic subdural hematoma mostly occurs after minor head trauma. A small number of sick children are caused by hemorrhagic diseases. The ruptured blood vessel is very small and the hematoma is very thin. Hematoma forms cystic connective tissue capsule in the process of organization, and there is hypertonic protein liquid mixed with old blood in the capsule. Hematoma sac is semi-permeable, and cerebrospinal fluid can penetrate into the sac through this membrane, which increases the volume of hematoma. It takes a long time for the symptoms of brain compression to appear. The symptoms of chronic subdural hematoma are very similar to those of intracranial tumors. The main symptoms are increased intracranial pressure, and brain hernia may occur in the later stage. Cerebral angiography showed that there was an avascular zone between cerebral cortical blood vessels and skull.

The treatment of acute subdural hematoma is to clear the hematoma and stop bleeding. Hematoma is often accompanied by brain contusion and brain edema. After removing the hematoma, it is necessary to remove the necrotic and liquefied brain tissue and then decompress it. Bilateral exploration should be performed during operation. There are two kinds of operations for chronic subdural hematoma: ① drilling a hole in the skull to flush the hematoma cavity and draining it with a rubber tube. ② Craniotomy with bone flap to peel off hematoma capsule. The former is suitable for liquid hematoma, while the latter is suitable for hematoma with capsule formation. The latter operation is beneficial to the recovery of compressed brain tissue and is widely used.

4.3 Subarachnoid Hemorrhage Almost all severe head injuries are accompanied by subarachnoid hemorrhage. Bleeding mainly comes from brain contusion and laceration, and single blood vessel injury bleeding is rare.

A small amount of blood in subarachnoid space is mixed with cerebrospinal fluid, which is decomposed and absorbed without causing symptoms. Massive bleeding can cause "chemical meningitis", and its clinical manifestations include severe headache, nausea, vomiting, shoulder or waist pain, high fever, stiff neck, positive Kernig and Bruzinski signs, etc. The diagnosis can be made if the cerebrospinal fluid is bloody. Repeated lumbar puncture and release of bloody cerebrospinal fluid can relieve symptoms. If there is arachnoid adhesion and cerebrospinal fluid circulation is blocked, it can develop into hydrocephalus.

4.4 Intracerebral hematoma is the rupture of blood vessels, bleeding of small blood vessels and capillaries in the brain parenchyma during brain contusion, which is characterized by punctate bleeding or scattered small hematoma in the brain; Hemorrhage from great vessels forms intracerebral hematoma. Hematoma is located in subcortical, deep brain, brain stem or cerebellum, and occasionally breaks into subarachnoid space and ventricle. The most common sites are temporal lobe and frontal lobe.

Intracerebral hematoma often lacks typical symptoms, generally including primary brain injury and secondary brain compression. There are progressive disturbance of consciousness and corresponding localized symptoms (hemiplegia, localized epilepsy). Diagnosis usually needs the help of cerebral angiography, X-ray and computed tomography.