About%. Divided into chronic and acute epidural hematoma, of which acute epidural hematoma (acute
extradural
Hematoma) is more common.
(1) Causes and pathology of injury:
Typical acute epidural hematoma is common in young and middle-aged male patients with linear skull fracture, especially in frontotemporal region and parietal region, which is related to the fact that the temporal region contains meningeal arteries and veins and is easily torn by fractures. The size of hematoma is closely related to the severity of the disease, and the bigger it is, the heavier it is.
(2) Symptoms and signs
The clinical manifestations of epidural hematoma may vary with bleeding speed, hematoma location and age, but from the clinical characteristics, there is still a certain regularity and * * *, that is, coma after waking up.
Consciousness disorder: Due to the different degrees of primary brain injury, there are three different situations in which the consciousness of such patients changes:
Increased intracranial pressure: With the increase of intracranial pressure, patients often have headache, vomiting, restlessness and typical changes of four curves, namely Cushing's reaction, which leads to compensatory reactions such as increased blood pressure, increased pulse pressure difference, increased body temperature, slowed heart rate and slowed breathing. When they fail, their blood pressure drops, their pulse is weak, and their breathing is suppressed.
Signs of nervous system: there are few signs of nerve damage in the early stage of simple epidural hematoma, and only when hematoma forms and compresses the brain functional area can there be corresponding positive signs. If the patient has symptoms and signs such as facial paralysis, hemiplegia or aphasia immediately after the injury, it should be attributed to the primary brain injury. When the hematoma continues to increase, the patient will not only have deeper disturbance of consciousness and disorder of vital signs, but also have typical signs such as dilated pupils on the affected side and hemiplegia on the opposite limb. Occasionally, due to the rapid development of hematoma, atypical signs can be caused: dilated contralateral pupil, contralateral hemiplegia; Unilateral mydriasis and ipsilateral hemiplegia; Or the opposite pupil is dilated and the ipsilateral hemiplegia occurs. The location should be checked immediately with the help of auxiliary inspection.
(3) Diagnosis and differentiation
The early diagnosis of supratentorial acute epidural hematoma should be judged before the signs of temporal hook hernia appear, not after the coma deepens and the pupils dilate. So clinical observation is very important. When patients have increased headache and vomiting, restlessness, elevated blood pressure, increased pulse pressure difference and/or new signs, they should highly suspect intracranial hematoma and give necessary imaging examinations in time, including X-ray skull plain film, A-mode ultrasound, cerebral angiography or ct scan.
(4) Treatment and prognosis
In principle, the treatment of acute epidural hematoma should be operated as soon as possible after diagnosis, and the hematoma should be excluded to relieve intracranial hypertension, and appropriate non-surgical treatment should be given according to the condition after operation. Generally, if there are no other serious complications, the primary brain injury is mild and the prognosis is good.
1) surgical treatment: craniotomy with bone window or bone flap is usually used to completely remove hematoma and stop bleeding, and subdural exploration is carried out when necessary. This is a long-standing surgical method to treat epidural hematoma. In recent years, due to the extensive application of CT scanning, the location, size and brain injury of hematoma are well known, and the changes of hematoma can be observed dynamically. Therefore, some authors have successfully used skull drilling to drain epidural hematoma.
2) Non-surgical treatment: Acute epidural hematoma should be treated promptly and reasonably whether it is operated or not.
Conservative treatment of epidural hematoma: suitable for conscious and stable patients; CT examination showed that the hematoma volume was less than 40ml and the midline displacement was less than 65438±0.5cm. Unconscious deterioration, fundus edema, new symptoms; Non-middle cranial fossa or posterior cranial fossa hematoma. Under the premise of closely observing the clinical manifestations of patients, the treatment measures should be dehydration, hormones, hemostasis and drugs for promoting blood circulation and removing blood stasis, such as Danshen and Chuanxiong, and cooperate with CT dynamic monitoring to ensure safety.