What Is an Intracerebral Hematoma?
Acute intracerebral hematoma refers to a hematoma in the brain parenchyma that can occur anywhere in the brain tissue. It occurs in the frontal and temporal lobe, accounting for 80% of the total, followed by the parietal and occipital lobe, which account for about 10%. The rest are located in the deep brain, basal ganglia, brain stem and cerebellum. The superficial intracranial hematomas located in the frontal, anterior, and bottom parts are often associated with cerebral contusions and subdural hematomas, and the clinical manifestations are rapid. Deep hematomas, more than in the white matter of the brain, are caused by tearing and bleeding of deep blood vessels due to deformation or shearing of the brain. When there is less bleeding and the hematoma is smaller, the clinical manifestations are slower. When the hematoma is large, a hematoma located near the basal ganglia, thalamus, or ventricle wall can rupture the ventricle and cause intraventricular hemorrhage. The condition is severe and the prognosis is poor.
Basic Information
- Visiting department
- neurosurgery
- Common locations
- Frontal and temporal lobe front
- Common causes
- Caused by trauma
- Common symptoms
- Hemiplegia, aphasia, hemianopia, anaesthesia, and focal epilepsy
Causes of Acute Intracerebral Hematoma
- Acute intracerebral hematoma is the formation of hematomas and produces clinical symptoms and signs within 3 days after injury. The frontal and temporal lobes are most common, and most often coexist with cerebral contusion and subdural hematoma. Severe cerebral contusion due to frontal pole, temporal pole, and frontal-temporal lobes caused by occipital focus trauma, caused by subcortical arteriovenous laceration and bleeding. Intracerebral hematomas due to impact injuries or depression fractures caused by direct impact at the point of force are rare, accounting for about 10%, and can be found in the frontal, parietal, temporal, and cerebellum.
Clinical manifestations of acute intracerebral hematoma
- Most of the traumatic intracerebral hematomas are acute, and a few are subacute. The clinical manifestations of intracerebral hematomas depend on the location of the hematomas. Hematomas located in the frontal, temporal, and bottom areas are similar to hedge cerebral contusions and subdural hematomas, except for increased intracranial pressure. Physical signs. If the hematoma affects important functional areas, signs such as hemiplegia, aphasia, hemiopia, hemiplegia, and focal epilepsy can occur. Patients with intrahepatic hematoma caused by hedging cerebral contusion and laceration often have more persistent conscious disturbances after the injury, and have progressive aggravation. They have no intermediate consciousness improvement period, the condition changes quickly, and it is easy to cause cerebral hernia. Local hematoma caused by impact injury or dent fracture, slower development, in addition to the symptoms of local brain damage, often symptoms of increased intracranial pressure such as headache, vomiting, fundus edema, especially the elderly due to vascular fragility Increased, more prone to intracerebral hematoma.
Acute Intracerebral Hematoma Examination
- 1.CT scan
- Presented as a round or irregularly shaped uniform high-density mass with a CT value of 50-90Hu, surrounded by low-density edema bands, accompanied by changes in the shape of the ventricle pool, and displacement of the midline structure. Often accompanied by cerebral contusion and laceration and subarachnoid hemorrhage.
- 2. Magnetic resonance (MRI)
- Most are not used for the examination of acute brain hematoma. Most of the signals are T 1 and other signals, T 2 low signal, and T 2 low signal is more likely to show lesions.
Diagnosis of Acute Intracerebral Hematoma
- The diagnosis was confirmed based on the etiology, clinical manifestations and CT examination.
Acute Intracerebral Hematoma Treatment
- Surgical treatment
- The treatment of acute intracerebral hematoma is the same as that of acute subdural hematoma, both of which are combined with cerebral contusion and hematoma, and the two are often accompanied. Surgical methods mostly use bone window or bone flap craniotomy. After removing the subdural hematoma and frustrated and eroded brain tissue, the frontal and temporal lobe hematoma should be explored immediately and removed. For those with suspected ventricle puncture, ventricular puncture and drainage should be performed. For patients with simple intracerebral hematomas and slower-developing subacute patients, it should be determined according to the increase of intracranial pressure. For progressive exacerbation, there is a tendency to form cerebral hernia, and surgical treatment is still appropriate.
- In recent years, due to the increasing popularity of CT and the continuous improvement of puncture technology, puncture treatment of cerebral hematomas has been adopted by more and more doctors, and the success rate has continued to increase. Patients with the same amount of intracranial hematomas and combined injuries have successfully applied puncture treatment. Later, the sequelae were lighter and the cure rate was higher than those of craniotomy.
- 2. Non-surgical treatment
- Although a small number of intracerebral hematomas are acute, the brain contusion and laceration are not serious, the age is large, the hematomas are smaller, less than 20ml, the clinical symptoms are light, the consciousness is located in non-main functional areas, there are no signs of the nervous system, the condition is stable, or Those with intracranial pressure not exceeding 3.33kPa (25mmHg) can also be treated non-surgically. For a few chronic cerebral hematomas with cystic changes and normal intracranial pressure, no special treatment is required.