{"id":1724,"date":"2026-05-03T18:13:38","date_gmt":"2026-05-03T18:13:38","guid":{"rendered":"https:\/\/nevrohirurgija.mk\/?p=1724"},"modified":"2026-05-03T18:15:30","modified_gmt":"2026-05-03T18:15:30","slug":"hematoma-subdurale-subdural-hematoma","status":"publish","type":"post","link":"https:\/\/nevrohirurgija.mk\/?p=1724&lang=sq","title":{"rendered":"Hematoma subdurale (Subdural Hematoma)"},"content":{"rendered":"

\u00c7far\u00eb \u00ebsht\u00eb kjo gjendje dhe pse k\u00ebrkon konsultim neurokirurgjikal urgjent?<\/em><\/strong><\/p>\n

-Hematoma subdurale \u00ebsht\u00eb gjendja serioze n\u00eb t\u00eb cil\u00ebn gjaku grumbullohet midis kafk\u00ebs dhe trurit, konkretisht n\u00ebn mb\u00ebshtjell\u00ebsin e fort\u00eb t\u00eb trurit (dura mater). Mund t\u00eb jet\u00eb nj\u00eb lloj l\u00ebndimi jotraumatik ose traumatik i trurit q\u00eb mund t\u00eb jet\u00eb i rreziksh\u00ebm p\u00ebr jet\u00ebn dhe k\u00ebrkon ndihm\u00eb t\u00eb menj\u00ebhershme mjek\u00ebsore.<\/p>\n

\"\"<\/p>\n

Shkaqet<\/em><\/strong><\/p>\n

    \n
  1. Shkaku m\u00eb i zakonsh\u00ebm \u00ebsht\u00eb goditja n\u00eb kok\u00eb (r\u00ebnia, aksidenti me makin\u00eb, l\u00ebndimi sportiv ose sulmi fizik).<\/li>\n<\/ol>\n

     <\/p>\n

    Faktor\u00ebt q\u00eb rrisin rrezikun:<\/em><\/strong><\/p>\n

      \n
    1. Mosha: Te personat mbi 65 vje\u00e7, truri tkurret pak (atrophy), gj\u00eb q\u00eb i b\u00ebn venat e vogla t\u00eb shtrihen dhe t\u00eb lehta p\u00ebr t’u shp\u00ebrthyer, *k\u00ebputja e venave lidh\u00ebse \u2192 gjakderdhja n\u00eb hap\u00ebsir\u00ebn subdurale<\/li>\n
    2. Ila\u00e7et: P\u00ebrdorimi i antikoagulant\u00ebve (ila\u00e7e p\u00ebr hollimin e gjakut).<\/li>\n
    3. Alkoolizmi: Pirja kronike e d\u00ebmton m\u00ebl\u00e7in\u00eb, gj\u00eb q\u00eb e parandalon mpiksjen normale t\u00eb gjakut.<\/li>\n
    4. S\u00ebmundjet: P\u00ebr shembull, hemofilia.<\/li>\n<\/ol>\n

       <\/p>\n

      Simptomat p\u00ebr t\u00eb cilat duhet t\u00eb keni kujdes<\/em><\/strong><\/p>\n

      \u2013 Kok\u00ebdhimbja, p\u00ebrgjumja, konfuzioni
      \n\u2013 Dob\u00ebsia ose mpirja n\u00eb nj\u00ebr\u00ebn an\u00eb t\u00eb trupit
      \n\u2013 Problemet me t\u00eb folurin, shikimin ose humbjen e vet\u00ebdijes
      \n\u2013 Sulmet (konvulsionet)<\/p>\n


      \nLlojet e hematom\u00ebs subdurale<\/em><\/strong><\/p>\n

      I dallojm\u00eb llojet sipas shpejt\u00ebsis\u00eb s\u00eb paraqitjes s\u00eb simptomave:<\/p>\n

      Akut: Lloji m\u00eb i rreziksh\u00ebm. Simptomat paraqiten menj\u00ebher\u00eb pas l\u00ebndimit (nga minutat deri n\u00eb or\u00ebt). Presioni n\u00eb tru rritet me shpejt\u00ebsi. Akut: deri n\u00eb 72 or\u00eb pas l\u00ebndimit; rreziku i lart\u00eb i kompresimit masiv t\u00eb trurit.<\/p>\n

      Subakut: Simptomat paraqiten me vones\u00eb prej disa dit\u00ebsh deri n\u00eb jav\u00eb pas l\u00ebndimit. Subakut 3-21 dit\u00eb.<\/p>\n

      Kronik: M\u00eb i zakonsh\u00ebm te pacient\u00ebt e moshuar. Gjakderdhja \u00ebsht\u00eb e ngadalshme, nd\u00ebrsa simptomat mund t\u00eb paraqiten pas disa dit\u00ebsh ose jav\u00ebsh. Shpesh pacienti harron se ka pasur l\u00ebndim t\u00eb leht\u00eb n\u00eb kok\u00eb. Kronik >21 dit\u00eb.<\/p>\n

      \"\"<\/p>\n

      Procedurat diagnostikuese<\/em><\/strong><\/p>\n

      Skanimi TK (Tomografia e Kompjuterizuar): Standardi i art\u00eb p\u00ebr diagnostikim t\u00eb shpejt\u00eb n\u00eb gjendjet urgjente, vler\u00ebsimi i trash\u00ebsis\u00eb dhe zhvendosjes s\u00eb strukturave t\u00eb mesme t\u00eb trurit (midline shift).<\/p>\n

      MRI (Rezonanca Magnetike): P\u00ebr fotografi m\u00eb t\u00eb detajuar n\u00eb format kronike ose subakute.<\/p>\n

      Vler\u00ebsimi klinik: GCS, simptomat fokale neurologjike, pupilat.<\/p>\n

      Trajtimi i hematom\u00ebs subdurale<\/em><\/strong><\/p>\n

      Trajtimi konservativ, trajtimi kirurgjik?<\/p>\n

      Indikacionet p\u00ebr trajtimin konservativ:<\/u><\/strong> hematoma t\u00eb vogla, t\u00eb q\u00ebndrueshme pa efekt t\u00eb konsideruesh\u00ebm t\u00eb zhvendosjes (zakonisht trash\u00ebsia <10 mm dhe midline shift <5 mm) dhe statusi neurologjik i q\u00ebndruesh\u00ebm.<\/p>\n

      Masat: monitorimi spitalor, pozicionimi i kok\u00ebs 30\u00b0, optimizimi i funksioneve vitale, p\u00ebrmbysja e koagulopatis\u00eb, mbik\u00ebqyrja e shpesht\u00eb neurologjike, skanime CT kontrolluese n\u00eb 24-48 or\u00eb, ndonj\u00ebher\u00eb monitorimi i ICP-s\u00eb.<\/p>\n

      Indikacionet p\u00ebr trajtimin kirurgjik – kriteret<\/strong><\/p>\n

      Trash\u00ebsia >10 mm ose midline shift >5 mm \u2014 evakuimi operativ.<\/p>\n

      R\u00ebnia progresive e statusit neurologjik ose (glasgow coma score *GKS) me shenjat e kompresionit ose beb\u00ebzat e \u00e7rregullta, at\u00ebher\u00eb nevojitet nd\u00ebrhyrja urgjente p\u00ebr t\u00eb evakuuar gjakderdhjen.<\/p>\n

      Vendimi p\u00ebrshtatet sipas mosh\u00ebs, komorbiditeteve dhe terapis\u00eb antikoagulante.<\/p>\n

      Teknikat kirurgjikale<\/u><\/strong><\/p>\n

      Kullimi Burr Hole: m\u00eb shpesh p\u00ebr SDH kronike.<\/p>\n

      Kraniotomia: p\u00ebr hematomat akute t\u00eb dendura ose kur nevojitet hemostaza direkte.<\/p>\n

      Kraniektomia: p\u00ebr dekompresion n\u00eb edem\u00ebn\/herniacionin e shprehur t\u00eb trurit.<\/p>\n

      Parimet intraoperative: evakuimi i shpejt\u00eb, hemostaza themelore, vendosja e drenit subdural.<\/p>\n

      Kujdesi postoperativ<\/u><\/strong><\/p>\n

      Kujdesi NI\/INU, monitorimi i GCS\/ICP, TK kontrollues n\u00eb 24\u201348 or\u00ebt e para.<\/p>\n

      Kullimi mbahet sipas gjendjes klinike dhe radiologjike (shpesh 24-72 or\u00eb), me fasha sterile t\u00eb rregullta t\u00eb plag\u00ebve.<\/p>\n

      Korrigjimi i koagulopatis\u00eb, profilaksia e infeksioneve sipas protokollit lokal, strategjia e individualizuar antikonvulsive, rehabilitimi i hersh\u00ebm.<\/p>\n

      Vendimmarrja multidisiplinare p\u00ebr rivendosjen e antikoagulimit.<\/p>\n

      -Komplikimet e mundshme<\/p>\n

      Recidivi, infeksioni, epilepsia postoperative, deficitet neurologjike t\u00eb p\u00ebrhershme, hidrocefalusi (p\u00ebr shkak t\u00eb formave t\u00eb rralla).<\/p>\n

       <\/p>\n

      Konkluzioni<\/u><\/strong><\/p>\n

      Diagnoza e hershme dhe trajtimi n\u00eb koh\u00eb \u2014 konservator ose kirurgjikal sipas kritereve klinike dhe radiologjike \u2014 jan\u00eb thelb\u00ebsore p\u00ebr nj\u00eb rezultat m\u00eb t\u00eb mir\u00eb. Nd\u00ebrhyrja kirurgjikale \u00ebsht\u00eb e indikuar p\u00ebr trash\u00ebsi >10 mm, midline shift >5 mm ose p\u00ebrkeq\u00ebsimi neurologjik progresiv. Kujdesi postoperativ dhe qasja multidisiplinare jan\u00eb t\u00eb domosdoshme.<\/p>\n

      K\u00ebshilla t\u00eb dobishme!<\/strong><\/p>\n

      Udh\u00ebzuesi p\u00ebr sh\u00ebrimin n\u00eb sht\u00ebpi pas operacionit t\u00eb hematom\u00ebs subdurale p\u00ebr pacient\u00ebt.<\/p>\n

      T\u00eb nderuar pacient\u00eb, sh\u00ebrimi i suksessh\u00ebm pas operacionit n\u00eb kok\u00eb varet edhe nga kujdesi juaj n\u00eb sht\u00ebpi. Ju lutemi ndiqni me kujdes udh\u00ebzimet e m\u00ebposhtme:<\/p>\n

        \n
      1. Kujdesi p\u00ebr plag\u00ebn operative<\/li>\n<\/ol>\n

        Past\u00ebrtia: Mbajeni fash\u00ebn t\u00eb that\u00eb dhe t\u00eb past\u00ebr. Mos e prekni plag\u00ebn me duar t\u00eb ndyra.<\/p>\n

        Larja: Mos e lagni kok\u00ebn derisa t\u00eb hiqen penjt\u00eb (zakonisht 10-14 dit\u00eb pas operacionit), p\u00ebrve\u00e7 n\u00ebse neurokirurgu juaj ju thot\u00eb ndryshe.<\/p>\n

        Kruarja: \u00cbsht\u00eb normale ndjenja e kruarjes derisa sh\u00ebrohet. Shmangni kruarjen p\u00ebr t\u00eb parandaluar infeksionin.<\/p>\n

          \n
        1. Aktiviteti fizik dhe pushimi<\/li>\n<\/ol>\n

          L\u00ebvizja graduale: Rekomandohen sh\u00ebtitje t\u00eb shkurtra n\u00ebp\u00ebr sht\u00ebpi. Shmangni q\u00ebndrimin shtrir\u00eb n\u00eb t\u00eb nj\u00ebjtin pozicion p\u00ebr periudha t\u00eb gjata kohore.<\/p>\n

          Kufizimet: N\u00eb 4-6 jav\u00ebt e para, ngritja e sendeve t\u00eb r\u00ebnda (mbi 2-3 kg), p\u00ebrkulja e menj\u00ebhershme e kok\u00ebs posht\u00eb dhe ushtrimet e forta fizike jan\u00eb rrept\u00ebsisht t\u00eb ndaluara.<\/p>\n

          Gjumi: Flini me kok\u00ebn pak t\u00eb ngritur (p\u00ebrdorni dy jast\u00ebk\u00eb) p\u00ebr t\u00eb zvog\u00ebluar \u00e7do \u00ebnjtje.<\/p>\n

            \n
          1. T\u00eb ushqyerit dhe ila\u00e7et<\/li>\n<\/ol>\n

            L\u00ebngjet: Pini mjaftuesh\u00ebm uj\u00eb p\u00ebr t\u00eb shmangur dehidratimin dhe kapsll\u00ebkun (sforcimi gjat\u00eb jasht\u00ebqitjes rrit presionin n\u00eb kok\u00eb).<\/p>\n

            Terapia: Merrni ila\u00e7et e p\u00ebrshkruara (antibiotik\u00ebt, analgjetik\u00ebt ose ila\u00e7et kund\u00ebr sulmeve) sakt\u00eb n\u00eb koh\u00eb.<\/p>\n

            E r\u00ebnd\u00ebsishme: Mos merrni aspirin\u00eb ose ila\u00e7e t\u00eb tjera p\u00ebr hollimin e gjakut pa lejen e shprehur t\u00eb neurokirurgut tuaj.<\/p>\n

              \n
            1. Kur t\u00eb na kontaktoni MENJ\u00cbHER\u00cb?<\/li>\n<\/ol>\n

              K\u00ebrkoni ndihm\u00eb mjek\u00ebsore n\u00ebse vini re:<\/p>\n

              Ndryshime n\u00eb plag\u00eb: Rrjedhje l\u00ebngu (qelb ose gjak), skuqje, \u00ebnjtje ose er\u00eb t\u00eb pak\u00ebndshme.<\/p>\n

              Temperatur\u00eb e ngritur: Temperatur\u00eb mbi 38\u00b0C q\u00eb nuk ulet.<\/p>\n

              Shenjat neurologjike: Konfuzion i ri, p\u00ebrgjumje nga e cila \u00ebsht\u00eb e v\u00ebshtir\u00eb t\u00eb zgjoheni, kok\u00ebdhimbje e fort\u00eb q\u00eb nuk kalon me ila\u00e7e.<\/p>\n

              Sulme: Shfaqja e ng\u00ebr\u00e7eve n\u00eb trup ose humbja e vet\u00ebdijes.<\/p>\n

              Problemet me t\u00eb folurit ose shikimin: Turbullimi i papritur i shikimit ose v\u00ebshtir\u00ebsia n\u00eb shqiptimin e fjal\u00ebve.\u00a0*teksti i p\u00ebrgjithsh\u00ebm informativ p\u00ebr pacient\u00ebt<\/em><\/p>\n

              Dr. Siratel Haliti<\/em><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

              \u00c7far\u00eb \u00ebsht\u00eb kjo gjendje dhe pse k\u00ebrkon konsultim neurokirurgjikal urgjent? -Hematoma subdurale \u00ebsht\u00eb gjendja serioze n\u00eb t\u00eb cil\u00ebn gjaku grumbullohet midis kafk\u00ebs dhe trurit, konkretisht n\u00ebn mb\u00ebshtjell\u00ebsin e fort\u00eb t\u00eb trurit (dura mater). Mund t\u00eb jet\u00eb nj\u00eb lloj l\u00ebndimi jotraumatik ose traumatik i trurit q\u00eb mund t\u00eb jet\u00eb i rreziksh\u00ebm p\u00ebr jet\u00ebn dhe k\u00ebrkon ndihm\u00ebLeer M\u00e1s<\/p>\n","protected":false},"author":5,"featured_media":1636,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[101],"tags":[],"class_list":["post-1724","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized-sq"],"_links":{"self":[{"href":"https:\/\/nevrohirurgija.mk\/index.php?rest_route=\/wp\/v2\/posts\/1724","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/nevrohirurgija.mk\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/nevrohirurgija.mk\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/nevrohirurgija.mk\/index.php?rest_route=\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/nevrohirurgija.mk\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1724"}],"version-history":[{"count":3,"href":"https:\/\/nevrohirurgija.mk\/index.php?rest_route=\/wp\/v2\/posts\/1724\/revisions"}],"predecessor-version":[{"id":1729,"href":"https:\/\/nevrohirurgija.mk\/index.php?rest_route=\/wp\/v2\/posts\/1724\/revisions\/1729"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/nevrohirurgija.mk\/index.php?rest_route=\/wp\/v2\/media\/1636"}],"wp:attachment":[{"href":"https:\/\/nevrohirurgija.mk\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1724"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/nevrohirurgija.mk\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1724"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/nevrohirurgija.mk\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1724"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}