Intracranial Hematoma

Head injuries account for approximately 70% of traumatic accident deaths. Intracranial hematoma plays an important role in the death and disability that are associated with head injury. Intracranial hematoma is a serious and possibly a life threatening condition that often requires immediate medical attention. Many patients with intracranial hematoma harbor mass lesions that require emergency decompression. Other causes include brain tumors, liver disease, autoimmune syndromes and bleeding disorders.

The human brain floats within the skull. It is surrounded by cerebrospinal fluid which cushions the brain from the bounces of everyday movements. Sometimes it becomes impossible for the fluid to absorb the force of a sudden blow or a quick stop. Under such situations, the brain may slide forcefully against the inner wall of the skull and get bruised. An intra-cranial hematoma occurs when the blood vessel ruptures between the skull and the brain. The blood leaks between the brain and the skull. This collection of blood, hematoma, which is possibly clotted, compresses the brain tissue. Some hematomas require surgery to remove the blood clot whereas some others can be treated without surgery.

Symptoms of intracranial hematoma include headache, nausea, vomiting, lethargy and slurred speech. The pupils may appear of unequal size. Memory loss is often associated with head trauma. One may even forget that they have suffered a blow. These symptoms of intracranial hematoma may occur either immediately or several weeks or months after a blow has been received in the head.

Injury in the head is the most common cause of intracranial hematoma. Among elderly persons, even a mild head trauma is more likely to cause a hematoma in the brain. Hematoma resulting from injury in the head is classified as:

Subdural hematoma: This occurs when the blood vessels, most often the veins rupture between the brain and the dura mater which is the outermost of three membrane layers that covers the brain. The blood that leaks forms a hematoma. This compresses the brain tissue. The danger here is that if the hematoma keeps growing then there is a progressive decline in consciousness and possible death. The risk of subdural hematoma is greater in people who use aspirin or other anticoagulants regularly. Alcoholics and very young and very old people also stand to be affected by subdural hematoma. All types of subdural hematomas require medical attention as soon as the symptoms become apparent. Other wise permanent brain damage may be the result.

Epidural hematoma: This type of hematoma occurs when the blood vessel, usually the artery, ruptures between the surface of the dura mater and the skull. Morbidity and mortality from epidural hematoma is substantial unless immediate medical attention is given. The cause of epidural hematoma is most of the time road automobile accidents or any other traumatic injuries.

Intraparenchymal hematoma: When blood pools in the white matter of the brain, Intraparenchymal hematoma occurs. There may be multiple severe Intraparenchymal hematomas after a head trauma. Serious brain damage can occur, as the neurons can no longer communicate.

A physician may find it difficult to diagnose intracranial hematoma, as it may not be immediately apparent. It is better to seek medical advice after any significant blow has been received to the head and if the patient has lost consciousness or experiences symptoms such as headache, lethargy, nausea and vomiting. A CT scan or MRI scan is suggested to define the position and size of a hematoma.

After a head injury, doctors use medications such as corticosteroids and diuretics to control the edema in the brain after head injury. Often surgery is required. If the blood clot is localized and there is no excessive clotting, then perforation is made through the skull and the liquid is removed by suction. Large hematomas require opening of a section of the skull to remove blood clots.

It is essential to wear appropriate safety equipment and gadgets during sports, including helmet when riding, motorcycling, horseback riding, skating or doing any other activity that may result in injury to head. Chances of motor vehicle accidents can be minimized by wearing a seat belt.

Subungual Hematoma

If you had just slammed your finger on your car door and the pain is unbearable and the nail has turned black and blue, then you are likely to have Subungual hematoma. The nail hematoma is seldom serious but always painful.
Also called Runner's Toe or Tennis Toe, Subungual Hematoma is a collection of blood under the fingernail or toenail.

This may have been caused by an injury such as slamming the nail in a door or dropping a heavy object on the nail. Subungual Hematoma can occur when blood thinning or cancer treatment medicines are consumed or you have an autoimmune condition. Subungual Hematoma can be extremely painful for an injury of its size although otherwise it is not a serious medical condition.

Signs and symptoms

• A discoloration in red or purple or maroon under the nail after an injury.
  
• Throbbing and intense pain; pressure generated between the nail and the nail bed where the blood collects causes this pain.
  
• Swelling in the affected nail or toe.
  
• Tender to the touch.
  

Causes

Subungual hematomas commonly occur after a crush type of injury at the tip of the finger or toe – hitting your finger with a hammer, dropping a heavy object on your toe or closing your finger in a door. Subungual Hematoma may be caused by ill fitting shoes and insufficient space for the toes.

The condition also results from slamming a finger in a door or from sports activities such as climbing or hiking in a rugged terrain. Due to running injuries, a foot might have lost a toenail and this is exacerbated by poorly fitting shoes.

Subungual Hematoma that occurs from repetitive thrusting of the longest toe into a shoe's toe box is called jogger's toe or runner's toe. Here bleeding occurs from the nail bed underlying the nail plate.

Runners toe is caused by downward pressure or horizontal separation of nail plate from nail bed. Repetitive traumatic injury leads to bleeding and blood gets pooled underneath the toe nail. The deformed nail plate gradually grows out and is replaced by new nail plate several months later. Sometimes the toe may become painful and require surgical drainage.

Treatment of Subungual Hematoma

A small hole is made in the nail to drain the blood. This will decrease pain and swelling. Following commonly used methods for draining hematoma include:

Cautery, a battery operated device used to burn a hole in the nail until the blood is reached and drained out of the hole. In case the patient is using artificial acrylic nails which might be flammable, this method should not be used.

A large diameter needle is used to drill or bore into the nail to create a hole to allow the blood to drain out.

Nail removal may be done if the nail is damaged. The doctor may also have to repair the tissue under the nail. Although anesthesia is generally not required, a digital nerve block is recommended to be performed if the nail is to be removed.

A splint may be placed on the finger or toe to prevent movement and protect the area while it heals. Subungual hematoma may typically heal without incident, although infection of the nail may occur.

Caring for Subungual hematoma

Keep injured finger or toe dry as long as directed.

Trim nails gently if it begins to fall off in pieces. This may decrease risk for catching the nail on an object or ripping it off.

Wear shoes that are comfortable and fit correctly to prevent injury to the toe.

Ice is used to elevate the affected finger. Place ice wrapped in a towel over the painful area for as long as directed and then elevate hand or foot on pillows above the level of the heart to help decrease swelling and pain.

If the nail was removed by the injury and the nail bed is not cut, then it is recommended to have the following home treatment done until the nail bed begins to be less sensitive, usually in a week to ten days. Twice daily soak with antibacterial soap and water for ten to fifteen minutes. After soaking, apply a topical antibiotic ointment and a dry sterile bandage.

Prevention

Exert caution when dealing with heavy objects. While on some high risk jobs, used steel toed shoes. Watch children's hands while opening and closing doors. Give full attention to the task on hand. Finger injuries often happen when the person using the hammer is distracted. In case of heavy objects, find people who can carry them – instead of dropping them on your toes.

Epidural Hematomae

Epidural hematoma, also referred to, as extradural hematoma is a collection of blood between the brain's tough outer membrane called the dura mater and the skull. This condition is very hazardous as the bleeding builds up pressure in the intracranial space thereby constricting the brain tissue and therefore requires immediate monitoring by physicians. Common reasons for epidural hematoma:

• A blow to head due to a road accident.
  
• Falling from a height and thus sustaining head injury.
  
• Any type of head injury that can lead to a skull fracture.
  

Symptoms of epidural hematoma range from severe headache and giddiness to increased size of one of the pupils of the eye. Rarely does a patient suffer seizures. With severe cases of epidural hematoma or as time elapses since the injury lethargy, unconsciousness, unable to arouse from deep sleep (at times lead the patient to coma) can occur. After studying the CT scan and depending on the extent of the damage caused, a neurosurgeon will recommend surgery.