Cranial hematomas (injury)
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Transcript of Cranial hematomas (injury)
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Cranial Hematomas
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Hematoma• Localized collection of blood outside the blood vessels, & then coagulate and solidify before blood is reabsorbed.
Disease: sickle cell disease, infection, tumorsTrauma: injury or surgery• Hemorrhage is active or ongoing bleeding. • Hematoma is a pathologic collection of blood in body tissues, outside of blood vessels.
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ClassificationLoaction• Cranial hematoma• Subdermal hematoma• Breast hematoma• Perichondral hematoma• Perianal hematoma• Subungual hematomaSize• Petechia < 2 mm• Purpura 2 mm – 1 cm• Bruise (ecchymosis, contusion) > 1 cm
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Cranial hematomas• Intra-axial (cerebral) hematoma:• Intraparenchymal• Intraventricular• Extra-axial hematoma:• Epidural• Subdural• Subarachnoid
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Caput succedaneum• Between the scalp and the periosteum.• Caused by the pressure of the presenting part of the scalp against the dilating cervix during delivery.• Presents as a scalp swelling that extends across the midline and over suture lines and is associated with head molding.• Usually resolves over the first few days.• Management consists of observation only.
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Subgaleal hematoma• Occurs in the space between the skull periosteum and the scalp galea (epicranial) aponeurosis.• Ruptures the emissary veins.• Ventouse (vacuum extraction): used in the second stage of labour if it has not progressed adequately.• Raccoon eyes, hemorrhagic shock, hyperbilirubinemia.
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Cephalohematoma• Occurs between the skull and the periosteum of a newborn secondary to rupture of blood vessels crossing the periosteum.• Due to prolonged second stage of labor or instrumental delivery.• Jaundice, anemia, hypotension• Risk of infection: osteomyelitis, meningitis• Differential diagnosis: subgaleal hematoma
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Epidural hematoma• Mostly originate from meningeal arteries, particularly in the temporal region.• Commonly results from a blow to the side of the head.• Anterior division of the middle meningeal
artery runs underneath the pterion.• Lucid interval, unconsciousness, loss of pupillary light reflex, Cushing’s triad.
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Subdural hematoma• Between the dura mater and arachnoid mater.• Results from tears in bridging veins which cross the subdural space.• Slower onset than epidural.• Life-threatening when acute, but better prognosis if chronic.• Increased intracranial pressure leading to gradual increase of headache & confusion with slowly progressive neurologic deterioration.
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Subarachnoid hematoma• Between the arachnoid membrane and the pia
mater.• ~85% rupture of a cerebral aneurysm.• They tend to be located in the Circle of Willis and its branches.• Thunderclap headache, vomiting, seizures, decreased level of consciousness, hemiparesis, Terson syndrome.
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