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 factors related to the production of bleeding include:- The relationship between head size and chain diameter genital;- Stiffness genital canal;- During labor;- Birth handle.
Etiology:
There are three major varieties of subdural hemorrhage:- Dilacerari tentoriale with sinus fracture right vein of Gallen, lateral sinus;- Dilacerari tent of the brain, the inferior sagittal sinus rupture;- Ruptured superficial cerebral veins.
Clinical signs:
Initially, the infant, usually on time, develop a syndrome manifested by Pontin: stupor, coma, eye deviation, unequal pupils dilated pupillary response to light unsteady, impaired breathing, stiffness or opistotonus.Subdural hemorrhage over the cerebral convexity is associated with at least 3 clinical grades: Grade I-minor degree of bleeding without apparent clinical signs, grade II can signs of brain injury, especially focal seizures that can be and often is associated with hemiparesis, deviation of the eyes with hemiparesis or eyes, the 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 chronic subdural effusions next few months
Diagnosis:
In a positive diagnosis of subdural hemorrhage have an important role laboratory diagnosis.
Computed Tomography is a non-invasive method of choice.Cranial ultrasound can not detect small hemorrhages located on the posterior fossa convexity of the brain, but can diagnose a large hemorrhage.Diastase occipital skull radiography can diagnose and skull fracture
Treatment:
Inerventia surgical therapy of this disease is paramount, 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 destruction or stick tentoriale brain is wrong. Death occurs in 45% of cases and survivors presents most of hydrocephalus and other neurological sequelae.Infants with subdural hemorrhage light, small, are neurologically normal evolution, in 50%. A serious factor is the association with hypoxic ischemic injury.