Traumatic brain injuries continue to be a serious public health problem worldwide. Approximately 1.4 million people suffer head trauma each year in the United States. Approximately 1/3 of all deaths occur from traumatic brain injury. According to the data of the State Institute of Statistics, the total number of accidents involving death and injury in our country in 2006 was 96,128, while the number of deaths was 4,633 and the number of injured was 169,080. Studies conducted over the last 30 years have shown that intensive and specialized treatment programs reduce disability and death in traumatic brain injury. However, despite intensive treatments, the majority of cases with severe head trauma remain disabled for a long time or die. Even in cases with moderate head trauma, significant neurophysiological and psychiatric damage may remain.
The main goal in the treatment of head trauma is to prevent secondary damage. What is meant by secondary damages; Brain edema seen after trauma is a decrease in blood flow (brain nutrition) in the brain, an increase in intracranial pressure, and as a result of all these, brain damage continues to progress after the trauma. Unfortunately, today only treatments aimed at reducing the secondary damage mentioned can be applied, and brain cells that are irreversibly damaged at the time of damage cannot be treated.
Head traumas; They can be grouped under three main headings: mild, medium and severe head trauma. We determine under which heading we will evaluate a patient who has suffered a head injury, based on a scoring system called the Glasgow Coma Score (GCS), which indicates the patient's state of consciousness.
We can group the lesions due to head trauma under two main headings. These; They are focal (limited to a certain area) lesions and diffuse (widespread) lesions.
Focal lesions
Epidural Hematoma (Bleeding): These are bleedings that occur between the membrane surrounding the brain (dura) and the skull bone and are not directly related to the brain. However, if bleeding continues and their size increases, they can compress the brain and cause damage. They constitute less than 1% of all head injuries. It often occurs as a result of broken bone edges cutting the vessels on the dura. Sometimes as a result of bleeding from the edges of broken bones also occurs. In rare cases, it may also originate from the main veins of the brain. The damage they cause to the brain is limited. Postoperative results are linked to the patients' neurological status (Glaskow Coma Scores) before undergoing surgery. In other words, patients who undergo surgery with a poor state of consciousness are more likely to have post-operative disability. In some patients, the extent of bleeding is not at a level that requires surgery and they are followed under close observation in the hospital. Some patients require urgent surgery. During the surgery, the skull bone in the area where the bleeding occurs is removed, the bleeding is cleaned and the source of the bleeding is stopped. Finally, the surgery is completed by fixing the removed bone back into place.
Tomography image of a typical epidural bleeding (white area shown with yellow arrows).
Subdural Hematoma (Bleeding): They are bleedings that occur between the meninges (dura) and the brain. In other words, the bleeding is in direct contact with the brain. They are more common than epidural hematomas. Its incidence is 30%, especially in cases with severe head trauma. Bleeding is usually caused by the rupture of the bridging vessels between the brain and the meninges (dura) at the time of trauma. If the trauma is very severe, then it may be directly related to bleeding of the damaged brain tissue. Sometimes (more common in older people, those who consume alcohol, or those who use blood thinners), subdural hematoma may develop weeks or even months after a light blow to the head. This is called chronic subdural hematoma. The consequences of acute (developing immediately after trauma) subdural hematoma are much worse than epidural hematomas. One of the biggest reasons for this is that these hemorrhages are often seen together with brain injury. The high mortality rate of subdural hematomas can be reduced with prompt surgical intervention and aggressive intensive care treatment. Treatment for subdural hematomas is similar to that of epidural hematomas. Differently, since the bleeding is under the cerebral membrane, this membrane is also removed and the bleeding is drained. In other words, there is direct contact with the brain. This increases the possibility of surgery-related complications.
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