Hematoma

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1- Introduction

2- Types of Hematoma

Introduction

A hematoma is a localized collection of blood outside the blood vessels, usually in liquid form within the tissue. Hematomas can occur in any part of the body and are often the result of an injury or trauma that causes blood vessels to break and bleed into the surrounding tissue.

Types of Hematoma Regarding to Neuroanatomy

1. Epidural Hematoma (Extradural Hematoma)

Location: Between the dura mater (the outermost meningeal layer) and the skull.

Causes:

  • Often associated with head trauma, particularly with skull fractures that damage the middle meningeal artery.
  • Can also result from arterial bleeds, making it a rapidly expanding hematoma.

Symptoms:

  • Loss of consciousness followed by a lucid interval, then rapid deterioration.
  • Severe headache, nausea, vomiting.
  • Neurological deficits, such as hemiparesis (weakness on one side of the body).
  • Dilated pupil on the side of the hematoma due to cranial nerve III compression.

Treatment:

  • Emergency surgical evacuation (craniotomy) to relieve pressure.
  • Monitoring and supportive care in less severe cases.

 

 

2. Subdural Hematoma

Location: Between the dura mater and the arachnoid mater.

Causes:

  • Commonly results from tearing of bridging veins due to head trauma.
  • More frequent in elderly individuals and those with cerebral atrophy or on anticoagulant therapy.
  • Can be acute (following severe trauma), subacute, or chronic (developing over weeks).

Symptoms:

  • Acute: Symptoms can be similar to those of epidural hematomas but with a slower onset.
  • Chronic: Progressive headache, confusion, lethargy, and neurological deficits like motor weakness.

Treatment:

  • Surgical drainage or burr hole craniotomy for acute cases.
  • Monitoring and conservative management for smaller, stable hematomas.

 

 

3. Subarachnoid Hematoma (Subarachnoid Hemorrhage)

Location: Between the arachnoid mater and the pia mater, within the subarachnoid space where cerebrospinal fluid circulates.

Causes:

  • Rupture of cerebral aneurysms or arteriovenous malformations (AVMs).
  • Trauma can also cause subarachnoid bleeding.

Symptoms:

  • Sudden, severe headache (“thunderclap headache”).
  • Neck stiffness, photophobia (sensitivity to light).
  • Nausea, vomiting, loss of consciousness.
  • Neurological symptoms like focal deficits or seizures.

Treatment:

  • Neurosurgical intervention to repair aneurysms or AVMs.
  • Management of increased intracranial pressure.
  • Supportive care, including blood pressure control and pain management.

 

 

4. Intracerebral Hematoma (Intracerebral Hemorrhage)

Location: Within the brain parenchyma itself.

Causes:

  • Hypertension, which can cause small vessel rupture.
  • Trauma, anticoagulant therapy, bleeding disorders.
  • Vascular malformations, tumors, or amyloid angiopathy.

Symptoms:

  • Sudden onset of focal neurological deficits, such as hemiparesis, aphasia (language disturbances).
  • Headache, vomiting, decreased level of consciousness.
  • Seizures may occur.

Treatment:

  • Medical management of blood pressure and intracranial pressure.
  • Surgical evacuation for large or accessible hematomas.
  • Rehabilitation for recovery of neurological functions.

 

 

5. Intraventricular Hematoma

Location: Within the ventricular system of the brain.

Causes:

  • Often associated with other types of intracranial hemorrhages (e.g., subarachnoid hemorrhage, intracerebral hemorrhage).
  • Can result from trauma, aneurysm rupture, or vascular malformations.

Symptoms:

  • Similar to other intracranial hemorrhages, with added symptoms of increased intracranial pressure.
  • Hydrocephalus (accumulation of cerebrospinal fluid) due to blockage of ventricular pathways.

Treatment:

  • Management of increased intracranial pressure.
  • Surgical intervention, such as ventriculostomy, to drain blood and relieve pressure.
  • Addressing underlying causes.
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