Subdural and epidural brain hematoma: symptoms, treatment and consequences

Intracranial lesions resulting from head injuries or penetrating wounds can cause serious brain damage. One such injury, concomitant with concussions and bruises of the head, is brain hematoma. The reasons for their occurrence are quite extensive and varied. Hematoma, depending on its location, can be very dangerous.

Description of the disease and its features

in adults

Internal hemorrhages in adults can be caused by serious injuries and strokes that may seem to be mild. The elderly are particularly vulnerable to the formation of hematomas.

This is facilitated by the predisposition of the vessels to ruptures and injuries, increasing with age and provoked by various diseases.

in children

Young children, especially up to 3 years old, are not yet able to fully control the coordination of movements, assess the degree of danger and properly amortize the fall. Frequent bruises and craniocerebral injuries of children are also caused by a greater weight of the head relative to the rest of the body.

In pediatric traumatology, the diagnosis of "concussion" and concomitant hematomas of the brain are very common.

in newborns

The infant's skull is not yet strong enough, and its bones can not serve as a full protection against serious injuries. The cause of cerebral vascular injury in newborns is, as a rule, severe labor with complications.

Head injuries can be obtained by passing through the birth canal, as well as at the time of retrieval of the newborn.

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Types of hematomas( classification)


This type of hemorrhage occurs as a result of vascular damage( mainly venous) between the medulla. Subdural hematoma is considered a dangerous injury, which carries a potential threat to the life of the patient.

Between the two medullary membranes( in most cases between the hard and soft), a local accumulation of blood is formed. If such a hematoma increases, it is expressed in the progressive fading of consciousness.

Subdural hematomas are divided into 3 types:

  • Acute - the most serious and dangerous hematomas caused by head injuries. Manifestations are detected immediately after damage.
  • Subacute - symptoms appear several hours after the injury.
  • Chronic - caused by less dangerous damage to the head. Bleeding with this type of hematoma is weak, so manifestations are found after days, and even months after the injury.

Any kind of subdural hematoma( especially, of course, acute) requires immediate treatment of the victim to the doctor.

Medical practice shows that the risk of subdural hematomas is higher in people who regularly take medications that affect blood clotting( eg, aspirin).

People who abuse alcohol( especially young and elderly people) are also at risk.


This hematoma appears when a large vessel is ruptured, more often an artery, between the surface of the solid shell of the brain and the skull. Often a blood vessel is damaged as a result of a fracture of the bones of the skull. The blood accumulating between the hard tissues strongly compresses the brain, exerting a serious influence on its functions.

Such a hematoma is often diagnosed in adolescents and children. The consequences of epidural hematoma are quite severe. Untimely medical care can lead to death.

Patients may remain conscious for a while, but they can not adequately perceive reality and are in a hindered and sleepy state. Sometimes the victims fall into a coma.


For this variety, hematomas are characterized by the penetration of blood out of the blood vessels directly into the brain substance.

Intracerebral hemorrhages provoke lesions of white matter of the brain and ruptures of nerve connections.

In particular, the neurites responsible for transmitting brain impulses to organs suffer. Thus, the nervous regulation of physiological processes in the body is disturbed.


This type of hemorrhage is characterized by the penetration of blood into the space between the arachnoid and the soft medulla, and occurs mainly due to rupture of the aneurysm( thinning of the vessels).Trauma to the head can also contribute to the formation of subarachnoid hematoma.

Less commonly, this hemorrhage is caused by:

  • atherosclerosis;
  • vascular malformation;
  • hemorrhagic diathesis;

Blood outgrowth as a result of subarachnoid hematoma, which has arisen from a non-traumatic cause, is characterized by acute pain( usually in the occipital part of the head) - as from a stroke. Often, this type of hematomas is accompanied by the penetration of blood into the eyeball and the retina of the eye.


Hematoma arising from the penetration of blood into the cerebral ventricles. Causes - trauma or hemorrhagic stroke. For intraventricular hematoma, the general cerebral symptomatology is a violation of the basic functions of the brain and a marked deterioration in state of health in the form of loss of consciousness and coma.

Especially severe consequences from this hematoma occur in the case of blockage of the outflow of cerebrospinal fluid( CSF).This can provoke hydrocephalus( edema of the brain).

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Hematoma after stroke

The following causes lead to hemorrhagic hemorrhage:

  • hypertension and hypertensive crisis;
  • atherosclerosis;
  • abnormalities of blood vessels;
  • acute intoxication of the body due to alcohol intake;
  • sunstroke;

The hematoma that results from a stroke is characterized by its vastness. It exerts pressure on surrounding tissues and causes a brain swelling and death of neurons.

This leads to serious and more often irreversible changes in the functioning of the central nervous system. A person who has suffered a stroke is disturbed by memory, speech( up to the total loss of ability to speak) and serious psycho-emotional transformations arise.

Causes and factors affecting the formation of hematomas

The human brain protects from cerebral spinal cords( cerebrospinal fluid), washing it in all directions and performing an amortization function.

However, with severe bruises and bumps, cerebrospinal fluid is not capable of providing full protection, and the brain strikes against the cranial walls.

In this case, there may be ruptures of blood vessels located in the brain itself or between its tissue and skull bones. These injuries are the immediate cause of hematomas.

Among the reasons are also:

  • aneurysm or malformation( pathological connection of veins and arteries);
  • brainstroke( same stroke);
  • blood pathology( hemophilia, leukemia, sickle-cell anemia);
  • autoimmune disorders( diseases caused by pathological behavior of cells responsible for eliminating foreign influences);
  • tumors and cysts of the brain;
  • liver disease;
  • chronic hypertension( high blood pressure);
  • appearance of hematomas is possible with the administration of certain medications( anticoagulants - substances that affect blood coagulability);
It should be said that injuries are far from the only factor affecting the formation of hematomas.

Symptoms and signs of hematomas

The severity of symptoms and the time of their appearance depends on the severity of the injury or disease, which was the root cause of the hematoma.

The most characteristic signs of cerebral hemorrhages are:

  • headache;
  • nausea;
  • drowsiness;
  • inhibition of psychophysical reactions;
  • speech slowness;
  • confused consciousness;
  • change in the diameter of the pupils;
  • loss of consciousness;
  • weakness in the arms and legs on one side of the body;

With extensive cerebral hemorrhage( as a result of severe injuries or stroke) symptoms can be more serious:

  • coma;
  • convulsions and convulsions;
  • lethargy( a condition similar to deep sleep, characterized by a slowdown of all processes in the body);

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It is not easy to detect the presence of bruises. Their symptoms may resemble other disorders of brain activity. In medical practice, it is commonly believed that a patient's loss of consciousness after a cranial trauma is accompanied by a hemorrhage in the brain. This diagnosis is considered correct until proven otherwise.

The exact dimensions and location of the hematomas are determined using hardware imaging techniques:

  • Computed tomography, which allows detailed images of any areas of the brain;
  • MRI( magnetic resonance imaging), the result of which are consecutive shots( slices) of the brain;

Brain hematoma photos


Regardless of the type of hematoma, the patient needs medical supervision and treatment. Therapeutic methods are used according to the indications of the hardware diagnosis and depend on the size of the hematoma, their location, the severity of the symptoms and the general condition of the patients.

If the hematomas are small and do not cause a significant deterioration in the patient's well-being, then:

  • He is prescribed medications from the group of corticosteroids and diuretics( this prevents cerebral edema);
  • The ice is applied to the patient's head and a pressure bandage is applied.
  • Additionally, physiotherapy procedures are prescribed.
Small bruises do not need surgery.

Large hematomas, which seriously affect a patient's condition, require surgical removal of blood from the brain cavities. This is done by puncture.

If the bleeding continues after the removal of blood, the surgeon performs trepanation( opening) of the skull, removes the bruise and binds the damaged vessel( or cliches, i.e., imposes special medical clips on it).

The operation is also necessary in cases of suppuration - the hematoma is opened and drained( sucked from the cranial cavity).Removal of hematomas must necessarily be carried out under the supervision of ultrasound or MRI in order to avoid unnecessary injury to the brain and, consequently, the occurrence of severe consequences.

On video operation to remove acute subdural hematoma:

Predictions and consequences, coma

Prognosis in case of small hematoma or timely removal of blood is favorable. Worse is the case with hematomas after a stroke. Restoration of all brain functions in a patient who has suffered a stroke may not occur.

Consequences of cerebral hemorrhages are extremely variable. Patients may develop asthenic syndrome - a state of chronic fatigue, rapid fatigue and increased meteosensitivity.

Damage resulting from pressure on the brain areas of the hematoma appears as:

  • irritability;
  • tearableness;
  • of neuroses;
  • psychosis;
  • dementia;

Extensive cerebral hemorrhage can lead to coma or even death of the patient. That is why any head trauma, how insignificant they would not seem to the injured, require compulsory treatment in medical institutions.

Even if the state of health has not worsened and no visible manifestations are observed, this does not mean that negative consequences will not arise in the future.
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