prof. Dr. Halil İbrahim Secer
Brain and Nerve Surgery (Neurosurgery)
Intracranial hemorrhages emerge as a serious health problem when evaluated together with today's traumatic factors and living conditions.
Traumatic ones: Epidural hemorrhages can be considered under separate headings as subdural hemorrhages, subarachnoid hemorrhages and intracranial hemorrhages.
I- Epidural Bleeding (Bleeding between the skull and the cerebral cortex)
This type of bleeding usually occurs as a result of ruptured bleeding of an artery as a result of fractures of the skull bone. Such an arterial hemorrhage rapidly accumulates by separating the cerebral cortex from the skull bone and quickly begins to show a mass effect pressing on the brain.
In the case of bleeding, it manifests itself as unconsciousness of the patient, impaired breathing, dilation of the pupils on the bleeding side and enlargement of the diameter.
II-Subdural Hemorrhages (Bleeding between the cerebral cortex and the brain)
These hemorrhages can be seen as acute, subacute and chronic hemorrhages. Bleeding detected within the first 3 days is considered acute, those detected between 3 days and 3 weeks are considered subacute, and those detected after 3 weeks are considered chronic. Acute and subacute hemorrhages can be more fatal than with post-traumatic brain injury and injury. Chronic subdural hematomas, on the other hand, are in the form of leakage as a result of the rupture of the veins forming the bridge between the cerebral cortex and the brain, and since they are hemorrhages that accumulate in the long term and create a mass effect, it is easier for the brain to tolerate it.
Chronic subdural hematomas may also occur after very mild or even minor head traumas that the patient cannot remember, especially in elderly patients. Because as we age, like all our organs, the brain begins to atrophy and shrink. As the brain shrinks, the distance between it and the cerebral cortex widens, causing the bridging veins to stretch like rubber. These bleedings often disappear on their own. However, especially in those receiving anticoagulant treatment, it may accumulate, and a greater amount of blood than the brain can tolerate can accumulate and press on the brain. Generally, after 2-3 months, the patient's neurological picture may deteriorate, for example, numbness in one side of the arm and leg, loss of strength, paralysis, speech disorder, gait disturbance, deterioration in intellectual functions or fainting. Definitive diagnosis is again made by computed tomography.
In order to eliminate the mass effect of this bleeding, this bleeding needs to be drained.
III- Post Traumatic Subarachnoid Hemorrhages (Bleeding between the meninges)
It can also occur after trauma, as a result of ballooning and bursting of vessels called aneurysms, or as a result of bleeding from the vein ball called AVM, bleeding between the layers of the cerebral membranes where the cerebrospinal fluid circulates. Treatment is usually in the form of medical treatment in post-traumatic bleeding. If there is a vascular pathology that causes bleeding, surgery is performed. This is a very serious picture and the death rate is high.
IV- Post Traumatic Intra-Cerebral Hemorrhages
These hemorrhages are very serious hemorrhages and are more serious than other hemorrhages since brain damage also occurs directly. They can occur in a range ranging from minor bleeding, which we can describe as tissue crushing after trauma, to very large hemorrhages. The location of the bleeding can be obtained in a short time by tomography and it can be determined whether the treatment will be surgical or medical treatment first.
Regardless of any type of bleeding, early detection of intracranial bleeding is very important, and it affects the whole process, from the determination of the treatment method to the patient's chance of survival.