Hematoma on head
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Summary
10 papers analyzed
These studies suggest that intracranial hematomas can develop after head injuries, may be detected using near-infrared spectroscopy or the TBI-Index, and often require prompt and sometimes aggressive treatment due to their association with poor outcomes.
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Hematoma on Head: Insights from Recent Research
Delayed and Recurrent Intracranial Hematomas in Head Injury Patients
Delayed and recurrent intracranial hematomas are a significant concern in patients with head injuries, particularly those with clotting abnormalities. A study involving 340 head injury patients found that 11 out of 12 delayed or recurrent hematomas were associated with disseminated intravascular clotting and fibrinolysis (DICF). This condition increases the risk of bleeding, especially in patients undergoing procedures like ventriculostomy. The study highlights the importance of monitoring clotting parameters in head injury patients to prevent delayed hematomas.
Acute Intracranial Hematomas Following Minor Head Injuries
Even minor head injuries can lead to the development of acute intracranial hematomas. An analysis of 183 patients who initially presented with minor head injuries but later required surgery for acute hematomas revealed that 54% had extradural hematomas. Symptoms such as altered consciousness, headache, and vomiting were common, and skull fractures were present in 60% of the cases. This underscores the need for vigilance and possibly imaging in patients with minor head injuries to rule out serious complications.
Detection of Delayed Intracranial Hematomas Using Near-Infrared Spectroscopy
Near-infrared spectroscopy (NIRS) has emerged as a valuable tool for the early detection of delayed intracranial hematomas. In a study of 167 patients, NIRS was able to identify hematomas before they caused significant mass effect or changes in intracranial pressure. This early detection is crucial for timely surgical intervention, potentially improving neurological outcomes. Another study confirmed the utility of NIRS in detecting intracranial hematomas, showing significant differences in optical density between the hematoma and normal sides of the brain.
Traumatic Basal Ganglia Hematomas in Severe Head Injuries
Traumatic basal ganglia hematomas (TBGHs) are particularly severe and often result in poor outcomes. A review of 37 cases found that these hematomas tend to enlarge during the acute post-traumatic period, with a high mortality rate of 59%. The study suggests that more aggressive surgical treatment may be necessary for larger hematomas or those causing increased intracranial pressure.
Rapid Identification of Hematomas Using Brain Electrical Activity
An index of brain electrical activity has shown promise in rapidly identifying intracranial hematomas in traumatic brain injury (TBI) patients. In a study involving 394 patients, this method demonstrated a sensitivity of 95.7% for detecting hematomas. This rapid identification can be crucial in emergency settings, allowing for quicker intervention and potentially better outcomes.
Epidural Hematomas: Recognition and Management
Epidural hematomas (EDHs) are a common result of traumatic head injuries and require urgent management. They are characterized by bleeding between the skull and the dura mater, often associated with skull fractures and arterial lacerations. The clinical manifestations can vary widely, including altered consciousness, headache, and seizures. Early diagnosis using CT scans is essential for effective management.
Calcified or Ossified Chronic Subdural Hematomas
Calcified or ossified chronic subdural hematomas (CSDHs) are rare but can cause slowly progressing neurological symptoms. A systematic review of 114 cases found that surgery is often the treatment of choice, with a complete recovery in 56.4% of patients. These hematomas should be considered in differential diagnoses, especially in patients with a history of head trauma or shunting for hydrocephalus.
Scalp Hematomas and Intracranial Injury in Pediatric Patients
In pediatric patients, scalp hematomas are significantly associated with intracranial injuries (ICI). A study of 3,866 children found that large and boggy hematomas, particularly in the temporal/parietal and occipital regions, had the strongest association with ICI. This association was most pronounced in children aged 0 to 6 months, indicating the need for careful evaluation of scalp hematomas in young children.
Conclusion
Intracranial hematomas, whether delayed, acute, or chronic, pose significant risks following head injuries. Advances in diagnostic tools like NIRS and brain electrical activity indices are improving early detection and management. However, vigilance in clinical assessment and timely imaging remain critical for preventing severe outcomes. Understanding the various presentations and risks associated with different types of hematomas can guide more effective treatment strategies and improve patient prognosis.
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