Clinical picture
An intracerebral hematoma is a collection of blood located in the substance of the brain, which causes its displacement and has a harmful effect on the adjacent brain tissue.
Brain tissue compressed by a hematoma is destroyed, resulting in the patient’s general condition worsening and can cause such a formidable complication as cerebral edema.
The clinical picture depends on the localization and volume of the hematoma :
- Headache ;
- Dizziness;
- Nausea;
- Vomiting (most often multiple);
- Impaired level of consciousness from mild stupor to coma;
- Movement disorders (paresis, paralysis on the opposite side);
- Sensitive disorders;
- Speech disorders.
With severe edema, compression of the brainstem occurs, in which all important centers of human vital activity are located, as a result of which respiratory and cardiovascular activity is impaired.
Factors of occurrence
A brain hematoma most often occurs as a result of traumatic brain injuries of varying severity, including blows, falls, or road accidents. However, in addition to traumatic factors, there are a number of other causes that can cause rupture of blood vessels in the brain and subsequent formation of a hematoma:
- Brain tumors . Tumors can compress blood vessels, disrupting their structure and causing hemorrhage.
- Arterial hypertension . Persistently elevated blood pressure significantly increases the risk of small blood vessels rupturing, which can lead to intracerebral hemorrhage.
- Arteriovenous malformations . Congenital vascular abnormalities where arteries and veins connect incorrectly, increasing the risk of rupture and bleeding.
- Vascular aneurysms . These are pathological expansions of the vascular walls that can rupture under the influence of various factors, leading to hemorrhage.
- Circulatory system diseases . Blood clotting disorders (such as hemophilia or anticoagulant therapy) can make it difficult to control bleeding and contribute to the formation of hematomas even with minor injuries.
The importance of early diagnosis and proper treatment of these conditions cannot be overstated, as timely intervention can significantly improve the prognosis for the patient.
Diagnostics
The most effective method for diagnosing intracerebral hematoma is computed tomography (CT). This method can accurately assess the volume of the hematoma, determine its exact location, and detect displacement (dislocation) or compression of brain structures. CT also allows you to assess the extent of tissue damage and helps doctors quickly decide on the need for surgery or other treatment methods.
Treatment
For small intracerebral hematomas that do not cause brain displacement or are not accompanied by significant neurological deficit, conservative treatment is performed, the patient is under constant supervision, and if the condition worsens, a repeated computed tomography scan is performed.
For large intracerebral hematomas, or small hematomas that cause displacement of the brain and compression of adjacent structures, neurosurgical treatment is performed, the essence of which is to decompress the brain with craniotomy and removal of the hematoma.
The bone flap is sewn into the subcutaneous fat of the anterior abdominal wall (after the patient’s condition is stabilized, cranioplasty is performed with the patient ‘s own bone flap).
The neurosurgical department performs all types of open surgeries for intracerebral hematomas.
