What is it about ?
The skull contains the brain. The brain is surrounded by 3 protective membranes called the meninges. The outermost meninge, against the bones of the skull, is called the dura.
Bleeding in the skull may occur
- between the skull and the dura mater, therefore outside the dura mater: we speak of an epidural or epidural or extradural hematoma;
- just under the dura: we speak of a subdural hematoma;
- in the brain itself: we speak of intracerebral hematoma orintracranial hemorrhage.
This bleeding can have different causes. The most common cause is trauma: a car accident, a fall, a blow to the head … Anticoagulant treatment can increase the risk of bleeding.
How to recognize them?
Consider bleeding in the skull if, after a head trauma, one of the following symptoms is present:
- headache, vomiting, confusion, agitation;
- loss of muscle strength or paralysis on one side, deformation of the mouth, decreased sensation on one side, or other neurological sign on one side;
- epileptic seizures,
- unconsciousness,
- dilated pupils.
It is important to make the diagnosis early, and certainly if the person is unconscious.
Epidural hematoma
The epidural hematoma mainly affects children and adolescents, for example after a fall.
It is necessary to call the emergency services urgently in the event of:
- rapid loss of consciousness;
- paralysis on one side of the body;
- dilation of a single pupil.
Subdural hematoma
Subdural hematoma can be acute, subacute or chronic:
- Symptoms of an acute subdural hematoma appear quickly. People who develop an acute subdural hematoma are often the elderly or people who have problematic alcohol use, and who have experienced trauma. Anticoagulant therapy increases the risk of bleeding. An acute subdural hematoma is often associated with brain contusion.
- Symptoms of a subacute subdural hematoma appear no earlier than 3 days after the trauma. People who develop a subacute subdural hematoma are often the elderly or people who have problematic alcohol use, who have experienced trauma.
- Symptoms of a chronic subdural hematoma appear a few weeks to months after the trauma. The trauma causing the hematoma is often mild. It is typically a fall, forgotten in the meantime. People who develop a chronic subdural hematoma are often elderly people, often on anticoagulants, who have had a fall. Symptoms usually develop quickly. It could be confusion, problems with balance, memory loss, headaches, or loss of strength on one side of the body.
Intracerebral hematoma or intracerebral hemorrhage
Intracerebral hematoma is most often associated with brain contusion diffuse. Sometimes there are several bleeds. The symptoms are then very diverse.
How is the diagnosis made?
In the event of neurological symptoms after an accident, the doctor always considers intracranial hemorrhage.
A CT scan is always necessary to make the diagnosis. It helps you see the bleeding, determine the severity of the bleeding and choose the most appropriate treatment.
What can you do ?
If you think you have an intracranial hemorrhage, it is important to get to the hospital as soon as possible, preferably by ambulance.
In the meantime, you should always immobilize the neck. So don’t turn the victim’s head.
Check breathing and pulse. If necessary, start artificial respiration and cardiac massage.
What can the doctor do?
Treatment depends on the location of the bleeding and the severity of the brain damage.
If possible, the blood is drained through an opening in the skull (trepanation or craniotomy). The pressure then goes down, and so do the symptoms.
If there is no brain injury, healing is almost always complete. In the event of brain damage, sequelae are possible. These treatments of course take place in a specialized hospital service.
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