Summary
Hematomas in head injuries as a general rule reach their definite size within minutes after the trauma, the bleeding being effectively checked by an interaction of an increased intracranial pressure and the natural hemostatic processes. In epidural hemorrhage the development of arteriovenous shunting in the epidural space may result in continuing bleeding. In special circumstances vascular injury may produce delayed hemorrhage related to increased transmural pressure in the vascular bed and the development of a hyperfibrinolysis syndrome. The clinical effect of a hematoma is quantitatively related to its volume, but modified to a considerable degree in the particular case by the size of the extraaxial space and the arterial blood pressure. Some implications for treatment are commented upon.
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References
Aronson SM, Okazaki H (1963) A study of some factors modifying response of cerebral tissue to subdural hematoma. J Neurosurg 20: 89–93
Ericsson K, Hâkansson S, Löfgren J, Zwetnow NN (1979) Extravasation and arteriovenous shunting after epidural bleeding. A radiological study. Neuroradiology 17: 239–244
Fogelholm R, Heiskanen O, Waltimo O (1975) Chronic subdural hematoma in adults. Influence of patient’s age on symptoms signs and thickness of hematoma. J Neurosurg 42: 43–47
Fukamachi A, Nagasaki Y, Kohno K, Wakao T (1985) The incidence and developmental process of delayed traumatic intracerebral hematomas. Acta Neurochir (Wien) 74: 35–39
Gennarelli TA, Thibault LE (1982) Biomechanics of acute subdural hematoma. J Trauma 22: 680–685
Greenberg J, Coken WA, Cooper PR (1985) The “hyperacute” extraaxial intracranial hematoma: Computed tomographic findings and clinical insignificance. Neurosurgery 17: 48–56
Habash AH, Zwetnow NN, Ericson K, Löfgren J (1983) Arteriovenous epidural shunting in epidural bleeding.Radiological and physiological characteristics. An experimental study in dogs. Acta Neurochir (Wien) 67: 291–313
Ito H, Komai T, Yamamoto S (1978) Fibrinolytic enzyme in the lining walls of chronic subdural hematoma. J Neurosurg 48: 197200
Ito H, Yamamoto S, Komai T, Mizukoshi H (1976) Role of local hyperfibrinolysis in the etiology of chronic subdural hematoma. J Neurosurg 45: 26–31
Kaufman HH, Moake JL Olson JD, et al. (1980) Delayed and recurrent intracranial hematomas related to disseminated intra-vascular clotting and fibrinolysis in head injury. Neurosurgery 7: 445–449
Loew F, Wüstner S (1960) Diagnose, Behandlung and Prognose der traumatischen Hämatome des Schädelinneren. Acta Neurochir (Wien) [Suppl] V III, Wien, Springer
Loew F, Kivelitz R (1976) Chronic subdural hematomas. In: Vinken PJ, Bruyns GW (ed) Handbook of clinical neurology, vol 24, part I I. North-Holland Publ Co, Amsterdam Oxford and American Elsevier Publ Co New York
Loew F (1982) Management of chronic subdural hematomas and hygromas. In: Krayenbühl H et al. (ed) Advances and technical standards in neurosurgery. Springer, Wien New York
Löfgren J, Zwetnow NN (1972) Kinetics of arterial and venous hemorrhage in the skull cavity. In: Brock M, Dietz H (eds) Intracranial pressure, experimental and clinical aspects. Springer, Berlin Heidelberg New York, pp 155–159
Markwalder TM, Seiler RW (1985) Chronic subdural hematomas: to drain or not to drain? Neurosurgery 16: 185–188
Schrader H, Löfgren J, Zwetnow NN (1985) Influence of blood pressure on tolerance to an expanding mass. Acta Neurol Scand 71: 114–126
Seelig JM, Becker DP, Miller JD, Greenberg RP, Ward JD, Chois SC (1981) Traumatic acute subdural hematoma. New Engl J Med 304: 1511–1518
Shenkin HA (1982) Acute subdural hematoma. J Neurosurg 57: 254–257
Steiner L, Bergvall V, Zwetnow NN (1975) Quantitative estimation of intracerebral and intraventricular hematoma by computer tomography. Acta Radiol (Stockh) [Suppl] 346: 143154
Steiner L, Löfgren J, Zwetnow NN (1975) Characteristics and limits of tolerance in repeated subarachnoid hemorrhage in dogs. Acta Neurol Scand 52: 241–267
Steiner L, Löfgren J, Zwetnow NN (1975) Lethal mechanism in repeated subarachnoid hemorrhage in dogs. Acta Neurol Scand 52: 268–293
Zimmerman RA, Bilaniuk LT (1982) Computed tomographic staging of traumatic epidural bleeding. Radiology 144: 809–812
Zwetnow NN, Habash AH, Löfgren J, Hâkansson S (1983) Comparative analysis of experimental epidural and subarachnoid bleedings in dogs. Acta Neurochir (Wien) 67: 67–101
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© 1986 Springer-Verlag
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Löfgren, J. (1986). Traumatic Intracranial Hematomas: Pathophysiological Aspects on Their Course and Treatment. In: Lindgren, S. (eds) Modern Concepts in Neurotraumatology. Acta Neurochirurgica, vol 36. Springer, Vienna. https://doi.org/10.1007/978-3-7091-8859-0_43
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DOI: https://doi.org/10.1007/978-3-7091-8859-0_43
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