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Tuesday, 29 October 2013

Dementia Treatments of Subdural hematoma In Conventional Medicine Perspective


I. Dementia
A. Dementia
About 5-8% of all people over the age of 65 have some form of dementia, and this number doubles every five years above that age. Dementia is the loss of mental ability that is severe enough to interfere with people's every life and Alzheimer's disease is the most common type of dementia in aging people. American typical diet contains high amount of saturated and trans fat, artificial ingredients with less fruits and vegetable which can lead to dementia and other kind of diseases.

B. Subdural hematoma
It is the accumulation of blood beneath the outer covering of the brain that result from the rupture of blood vessel. Subdural hemorrhages may cause an increase in tracranial pressure, which can cause compression of and damage to delicate brain tissue. Acute subdural hematoma has a high mortality rate.

II. Treatments of Subdural hematoma
1. Emergency treatment
An acute subdural hematoma (SDH) is a rapidly clotting blood collection below the inner layer of the dura but external to the brain and arachnoid membrane (see the first image below). Two further stages, subacute and chronic, may develop with untreated acute subdural hematoma (SDH)(1). There is always important to maintain survival of the patient with acute subdural hematomas. Emergency treatment be be necessary to reduce pressure and to allow blood to drain by drilling a small hole in the skull and  inserting a temporary small catheter through a hole drilled through the skull and sucking out the hematoma. . Although hematoma resolution has been reported, it cannot be reliably predicted, and no medical therapy has been shown to be effective in expediting the resolution of acute or chronic subdural hematomas(2)

2. Medication
Inn case of chronic subdural hematomas, mannitol may be used to reduce intracranial pressure (ICP) as it produced a significant reduction in ICP and improved cerebral perfusion pressure(3).
a. Corticosteroids for brain oedema
Methylprednisolone is a synthetic glucocorticoid or corticosteroid drug. Researchers at the suggested that Methylprednisolone can effectively reduce myelin changes accompanying brain oedema induced by blood-brain barrier opening with an osmotic insult(4).

b. Prophylactic antiepileptic drug for patient with seizures
In the study of a total of 129 patients treated for chronic subdural haematoma. None of 73 patients who were given prophylactic antiepileptic drug treatment developed seizures. Only two of 56 patients not given prophylaxis, developed early postoperative seizures(5).

c.  Rifampicin for bacterial infection
Rifampicinis a naturally made, non-peptide antibiotic. It is bactericidal, killing by disabling the protein expression system universally conserved by all bacterial causes of infection, but it can induce thrombocytopenia(6) in acute Subdural hematoma treatment.

3. Surgery
Large or symptomatic hematomas require a craniotomy, as a bone flap is temporarily removed from the skull to access the brain for removal of blood clot with suction or irrigation. Dr. Santarius T, and the research team at the University of Cambridge, Cambridge, UK. showed that Use of a drain after burr-hole drainage of chronic subdural haematoma is safe and associated with reduced recurrence and mortality at 6 months(7).


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Sources
(1) http://emedicine.medscape.com/article/828005-overview
(2) http://emedicine.medscape.com/article/1137207-treatment
(3) http://www.ncbi.nlm.nih.gov/pubmed/7936130
(4) http://www.ncbi.nlm.nih.gov/pubmed/22286794 
(5) http://www.ncbi.nlm.nih.gov/pubmed/8229039
(6) http://www.ncbi.nlm.nih.gov/pubmed/19782872
(7) http://www.ncbi.nlm.nih.gov/pubmed/19960218