CNS - Hematoma Flashcards
What causes an epidural hematoma?
A high-pressure arterial bleed, often from a meningeal artery branch, typically due to a skull fracture or traumatic impact.
Where does blood accumulate in an epidural hematoma?
Between the internal skull bone periosteum and the dura mater, snapping Sharpey’s fibers.
What happens as blood accumulates in an epidural hematoma?
Brain tissue collapses as blood fills the space; structural support is lost, increasing pressure and potential for brain damage.
Is there a window for treatment in an epidural hematoma?
Yes, early medical treatment can evacuate the blood and control damage. After the window closes, it is likely fatal.
When do symptoms of an epidural hematoma typically appear?
Within a few hours to 3 days from the impact.
What are the onset signs and symptoms (S/S) of an epidural hematoma?
• Very intense “unusual” headache with nausea/vomiting (like hemorrhagic stroke headache)
• Onset of neurological signs as brain tissue is compressed
• Signs of shock
• Altered consciousness, progressing to coma
• Reason why people are monitored/woken regularly after a concussion
What causes a subdural hematoma?
A venous bleed that occurs in the space between the dura mater and the brain.
Where does blood accumulate in a subdural hematoma?
Sometimes above the arachnoid mater, sometimes seeping below.
What are the three types of subdural hematoma?
• Acute: Due to head trauma; symptoms appear within minutes to hours; high fatality rate
• Subacute: Caused by head impact; develops more gradually with less intense symptoms
• Chronic: Subtle, slower bleed, often microvascular; common in seniors and babies; symptoms can take days to weeks to appear
What type of brain damage occurs in subdural hematoma?
The brain tissue does not collapse like in an epidural hematoma, but accumulating pressure can still cause substantial damage.
Q: What is the most common first symptom of a subdural hematoma?
Dystaxia
What are other common symptoms of subdural hematoma (all types)?
• Seizures
• Range of neurological signs based on affected brain tissue
• Developing confusion, altered consciousness, personality changes
What symptoms are common in acute and subacute subdural hematomas?
• Severe headache with nausea/vomiting (especially acute)
• Headache less prevalent in chronic type
What symptoms are common in chronic subdural hematoma?
• Confusion, disorientation, memory impairment
• Headache often absent
Why is it important for an RMT to be aware of subdural hematoma signs and high-risk groups?
Because symptoms can develop long after injury, and massage therapists may unknowingly treat a person with a developing subdural hematoma.
Which individuals are at high risk for subdural hematoma?
• People with a history of multiple head impacts or whiplash (e.g., car accidents)
• Professional drivers (e.g., taxi, courier)
• Contact sport athletes (football, hockey, soccer, MMA)
• Frequent fallers: seniors, young children, epilepsy patients, CNS conditions like MS or Parkinsonism
• Horseback riders/jockeys, skiers, gymnasts
• Alcoholics/addicts
• Construction and care workers (e.g., dealing with aggressive patients)
• Battered/bullied/abused individuals
• “Shaken babies”
Why are individuals over 75 at high risk for subdural hematomas?
• Brain tissue shrinks with age, increasing tension on fascial membranes and vessels
• Even minor impacts/whiplashes can cause bleeds
• Extra caution needed with head/neck movements and getting on/off the massage table
How should RMTs handle older clients in terms of safety?
• Be conservative with head/neck mobilizations
• Monitor closely for subtle symptoms
• Be cautious with positioning to avoid slip risks
• Maintain high alertness even after minor trauma reports
