7/28/2023 0 Comments Subdural hematoma blown pupil![]() The utilization of forceps or vacuum extraction devices that may occur during the extraction of the baby is of particular interest. The newborn who has experienced a traumatic birth often presents with a history of a difficult passage through the birth canal. In this context, any suspicion must trigger the proper clinical investigation and report to the authorities tasked for such an endeavor. ![]() Often, the clinician faces an injury that contradicts the history given by the caretaker. The history and physical examination in the infant and child may be problematic when it relates with abusive head trauma. There is no reported difference in gender for a subdural hematoma in the early stages however, accidental subdural hematoma caused by trauma in the teenage years favors the male gender. Developing countries report similar rates however, the data is very limited. The risk of developing a subdural hematoma is higher below the age of one year (1:4761) according to a study in South Wales, England with an incidence reaching up to 21 per 100,000 child-years in this age group. The result of epidemiological studies report these injuries under a common heading for child abuse. The data for abusive head trauma is more robust in Europe and the United-States than in other geographic areas, with an incidence up to 17 per 100.000 child-years. However, the incidence of subdural hematoma occurring in children less than 2 years reaches close to 13 per 100,000 child-years. Other injuries discovered with AHT include epidural hematoma, diffuse axonal injury and parenchymal injury among others. When there is a larger space between the dura mater and the brain, as seen in the young, growing brain or an aging brain (because of contraction), the cerebrospinal fluid (CSF) flows between bridging veins occupying a larger space. In this context, the structure stretches bridging veins and renders them prone to rupture. A small extravasation may resolve spontaneously. A larger bleed may augment the distance between the bridging veins and trigger an extensive amount of blood layering around the brain, slowly augmenting subdural space, decreasing the space of the brain leading to herniation of the cerebral structures.Ī subdural hematoma is one of the intracranial injuries associated with abusive head trauma (AHT). These so-called bridging veins may rupture when direct opposing forces rupture their thin walls, releasing blood under the dura mater forming a subdural hematoma. ![]() The inner surface of the skull toward the brain includes:įirst, there is a leather-like structure called the dura mater, derived from the neural crest, adhering to the periosteum and facing the other meningeal structure, the arachnoid mater. The arachnoid mater lies under the dura mater (middle meningeal layer) forming many villi piercing through the dura with bridging veins acting as one-way valves to drain the neural tissue lying underneath the last meningeal layer called the pia mater. The brain finds its protection under the skull by the meninges that comprise three layers. This network of neurons and neuronal connective tissue is prone to injury without the protective layers, starting with the scalp and the bony structures of the skull. The brain is the central repository of delicate neural tissue. The understanding of subdural hematoma relies on the knowledge of neuroanatomical sheets covering the brain. A subdural hematoma forms because of an accumulation of blood under the dura mater, one of the protective layers to the brain tissue under the calvarium.
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