Hemorrhage, Hematoma, and Tentorial Herniation: The 3 H’s of Cerebral Contusion
 Cerebral contusion is defined as the bruising of the brain tissue resulting from a severe blow in the head. It is considered to be more serious than cerebral concussion because contusion disrupts the normal nerve functions in the bruised area, resulting to loss of consciousness, cerebral hemorrhage or edema, and even death.
Other signs and symptoms include scalp wound, hemiparesis, labored breathing, unequal pupils, drowsiness, confusion, disorientation, agitation, or violence when conscious, temporary aphasia, and unilateral numbness after regaining consciousness.
Among the tests that diagnose cerebral contusion are: 1) skull x-rays to rule out fractures, which is also helpful in showing a shift in brain tissue; 2) cerebral angiography, which outlines vasculature; and 3) computed tomography, which shows ischemic or necrotic tissue and subdural, epidural, and intracerebral hematoma.
Among the most serious consequences of a head injury are hemorrhage, hematoma, and tentorial herniation. An epidural hemorrhage or hematoma results from a rapid accumulation of blood between the skull and the dura mater; a subdural hemorrhage or hematoma, from a slow accumulation of blood between the dura mater and the subarachnoid membrane. Intra-cerebral hemorrhage or hematoma occurs within the cerebrum itself. Tentorial herniation occurs when injured brain tissue swells and squeezes itself through the tentorial notch, constricting the brain stem.
Epidural hemorrhage or hematoma can cause immediate loss of consciousness, followed by a lucid interval lasting minutes to hours, which eventually gives way to a rapidly progressive decrease in the level of consciousness. Other effects are contralateral hemiparesis, progressively severe headache, ipsilateral papillary dilation, and signs of increased ICP; decreasing pulse and respirations and increasing systolic blood pressure.
With a sub-acute or chronic subdural hemorrhage or hematoma, blood accumulates slowly, so symptoms may not occur until days after injury. In an acute subdural hematoma, symptoms appear earlier because blood accumulates within 24 hours of the injury. Loss of consciousness occurs often with weakness or paralysis. Intra-cerebral hemorrhage or hematoma usually causes nuchal rigidity, photophobia, nausea, vomiting, dizziness, convulsions, decreased respiratory rate, and progressive obtundation.
Tentorial herniation causes drowsiness, confusion, dilation of one or both pupils, hyperventilation, nuchal rigidity, bradycardia, and decorticate or decerebrate posturing. Irreversible brain damage or death can occur rapidly.
Intra-cranial hemorrhage may require a craniotomy to locate and control bleeding and to aspirate blood. Epidural and subdural hematomas are usually drained by aspiration through burr holes in the skull. Increased ICP may be controlled with mannitol, I.V. steroids, or diuretics, but emergency surgery is usually required.
 December 23, 2009
 Tags: epidural hematoma, hematoma treatment, intracerebral hematoma, intracranial hemorrhage, subdural hematoma Posted in: earlysymptoms
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