Wednesday, March 9, 2011

Intracranial hemorrhage in newborns Subdural hemorrhage

Intracranial hemorrhage in newborns
Subdural hemorrhage
This type of bleeding is almost exclusively a traumatic injury of the newborn. The incidence is 5-10% of intracranial bleeding. Major bleeding associated with the production factors include: - The relationship between head size and chain diameter genital - Stiff genital canal; - During labor; - Birth handle.
There are three major varieties of subdural hemorrhage: - Dilacerari tentoriale with torn right sinus, vein of Gallen, lateral sinus; - Dilacerari tent of the brain, the inferior sagittal sinus fracture; - Rupture of superficial cerebral veins.
Clinical signs:
Initially, the infant, usually on time, develop a syndrome manifested by Pontin: stupor, coma, ocular deviation, unevenly dilated pupils, pupillary response to light inconstant, impaired breathing, stiffness or opistotonus. Subdural hemorrhage over the cerebral convexity is associated with at least three clinical grades: Grade I-minor degree of bleeding without apparent clinical signs, grade II signs of brain damage can occur, particularly focal seizures that can be and often is associated with hemiparesis, diversion of the eyes or eye hemiparesis, "doll"; Grade III clinical stage could be represented by the appearance of a subdural hemorrhage in the newborn period, with few clinical signs (tachypnea, child suffering), which develops in the next few months chronic subdural effusion
In a positive diagnosis of subdural hemorrhage is a very important role paraclinical diagnosis.
Computerized tomography is a non-invasive method of choice. Cranial ultrasound can not detect small hemorrhages located in the posterior fossa cerebral convexity, but it can diagnose a large hemorrhage. Skull X-rays can diagnose and diastase occipital skull fracture
The surgical treatment of this disease is paramount inerventia, in most cases. Convexity cerebral hemorrhage can be decompressed by subdural puncture and by craniotomy and posterior fossa massive hemorrhage may require craniotomy and aspiration of clots.
Complications and prognosis:
The prognosis of infants with major destructions or stick tentoriale brain is stupid. Death occurs in 45% of cases and survivors shows in most of hydrocephalus or other neurologic sequelae. Infants with mild subdural hemorrhage, small, in normal neurological development in 50%. A serious factor is the association with hypoxic ischemic injury.

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