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case study on subacute subdural hematoma

case study on subacute subdural hematoma

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Published by jarelle bondoc

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Published by: jarelle bondoc on Sep 02, 2009
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08/05/2013

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FATHER SATURNINO URIOSUNIVERSITY 
NURSING PROGRAMButuan City
An Individual Case StudyOn
Hemorrhagic ContusionRight Frontal LobeSubacute Subdural HematomaRight Convexity
Submitted by:
Bondoc, James Aurelle S
.
N30
Submittted to:
Ms Michelle Donna A. Dulu, RN
 
Supervising Clinical Instructor
 
INTRODUCTION
A subdural hematoma (SDH) is a common neurosurgical disorder that often requiressurgical intervention. SDH is a type of intracranial hemorrhage that occurs beneath the dura andmay be associated with other brain injuries. Essentially, it is a collection of blood over thesurface of the brain. SDHs are usually caused by trauma but can be spontaneous or caused by a procedure, such as a lumbar puncture.SDHs are usually characterized based on their size, location, and age (ie, whether theyare acute, subacute, or chronic). These factors, as well as the neurologic and medical condition of the patient, determine the course of treatment and may also influence the outcome.
SDHs are often classified based on the period that has elapsed from the inciting event (if known)to the diagnosis. When the inciting event is unknown, the appearance of the hematoma on CT scan or MRI can help determine when the hematoma occurred.Generally, acute SDHs are less than 72 hours old and are hyperdense compared with the brain onCT scan. Subacute SDHs are 3-20 days old and are isodense or hypodense compared with the brain.Chronic SDHs are 21 days (3 wk) or older and are hypodense compared with the brain. However, SDHsmay be mixed in nature, such as when acute bleeding has occurred into a chronic SDH.
The brain is covered by a membrane (layer of tissue) called the dura. If the veins located below the dura (subdural area) leak blood, then pressure in this area may build up and injure the brain. Head injuries may injure these veins, causing them to be torn and leak. This bloodcollects into a mass called a hematoma.`For the most part, this review discusses acute and chronic SDHs; less information isavailable about the less common subacute SDHs.
1
The entity of subdural hygroma is brieflyaddressed with chronic SDH.Acute SDH is commonly associated with extensive primary braininjury. In one study, 82% of comatose patients with acute SDH had parenchymal contusions.
2
The severity of the diffuse parenchymal injury correlates strongly (inverse correlation) with theoutcome of the patient. In recognition of this fact, an SDH that is not associated with anunderlying brain injury is sometimes termed a simple or pure SDH, whereas the termcomplicated has been applied to SDHs in which a significant injury of the underlying brain hasalso been identified.The practice of trephination of the head (ie, chipping or drilling a hole through the skull)has been traced back to ancient times. The author Balzac, in 1840, described a case of chronicsubdural hematoma (SDH), including its traumatic origin and surgical treatment.
3
In the late 19thcentury, with the rise of medicine, development of aseptic technique and anesthesia, andestablishment of the basic principles of neurologic localization, surgery for intracranial lesions(including SDH) became more common and, later, survival rates improved. In 1883, Hulke firstdescribed successful neurosurgical treatment of chronic SDH.
4
Although cerebral angiographycould be used to localize SDH in the early–to–mid-20th century, the development of the CT scanin the late 1970s represented another leap in patient care.It is important that a patient receive medical assessment, including a completeneurologicalexamination, after any head trauma. ACT scanor MRI scanwill usually detect significant subdural hematomas.Treatment of a subdural hematoma depends on its size and rate of growth. Some smallsubdural hematomas can be managed by careful monitoring until the body heals itself. Other small subdural hematomas can be managed by inserting a temporary small catheter through ahole drilled through the skull and sucking out the hematoma; this procedure can be done at the bedside. Large or symptomatic hematomas require acraniotomy, the surgical opening of theskull. A surgeon then opens thedura, removes the blood clotwith suction or irrigation, and identifies and controls sites of bleeding. Postoperative complications include increased
 
intracranial pressure, brainedema, new or recurrent bleeding, infection, andseizure. The injured vessels must be repaired.I choose this case since it catches first my interest. Having Craniectomy operation as myfirst major case assist really challenged me a lot to do my best during the operation. Efforts were being given and it took 4 hours of long standing for me before the operation ended. Being a partof that really means a lot to me indeed.
DEFINITION OF TERMS
 
Here are some of the terms that are being defined and could beencountered as one gets along with this case study.
Autoregulation-
is a specific form of homeostasisused to describe the tendency of the body tokeep blood flowconstant when blood pressure varies
Brain Death
- Irreversible brain damage and loss of brain function, as evidenced by cessation of  breathing and other vital reflexes, unresponsiveness to stimuli, absence of muscle activity, and aflat electroencephalogram for a specific length of time.
Brain herniation
- also known as
cistern obliteration
, is a deadly side effect of very highintracranial pressurethat occurs when thebrainshifts across structures within theskull.
Cerebral blood flow
- or 
CBF
, is the blood supply to thebrainin a given time.
Cerebral hypoxia-
refers to deprivation of oxygensupply to brain tissue.
Cerebral perfusion pressure
- or 
CPP
, is the net pressuregradient causing blood flow to the   brain(brain perfusion).
Compression
- A force squashing, squeezing, or pressing down on an object.
Contusion
- A bruise that is usually produced by impact from a blunt object and that does notcause a break in the skin.
Craniectomy
- surgical removal of a portion of the cranium.
Effusion-
the seeping of serous, purulent, or bloody fluid into a body cavity or tissue.
Hematoma- A
mass of blood in the tissue as a result of trauma or other factors that cause therupture of blood vessels.
Intracranial Pressure- Pressure
that occurs within the cranium. Trauma to the head,inflammation, or infection of the linings of the brain may cause an increase in pressure within thecranium, which is painful, dysfunctional, and may become life-threatening.

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