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A - MSRA Neuro and Stroke [12] > [3] Subdural Haematoma > Flashcards

[3] Subdural Haematoma Flashcards

1
Q

What is a subdural haematoma?

A

A collection of blood that forms in the subdural space

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2
Q

What is the subdural space?

A

The space between the dura mater and the arachnoid mater

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3
Q

What can subdural haematomas be classified as?

A
  • Acute
  • Subacute
  • Chronic
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4
Q

What is an acute subdural haematoma?

A

<3 days after injury

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5
Q

What is a subacute subdural haematoma?

A

3-21 days after injury

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6
Q

What is a chronic subdural haematoma?

A

> 21 days after injury

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7
Q

What can subdural haematoma be alternatively classified as?

A

Simple or complicated

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8
Q

What is a simple subdural haematoma?

A

No associated parenchymal injury

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9
Q

What is a complicated subdural haematoma?

A

Associated underlying parenchymal injury

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10
Q

What does bleeding in SDH occur from?

A

Tearing of the bridging veins that cross from the cortex of the dural venous sinuses

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11
Q

What are the bridging veins from the cortex of the dural venous sinuses vulnerable to?

A

Deceleration injury

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12
Q

What does bleeding from bridging veins in SDH lead to?

A

Accumulation of blood between the dura and arachnoid

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13
Q

What does the accumulation of blood between the dura and arachnoid lead to in SDH?

A

Gradual rise in ICP

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14
Q

What can the gradual rise in ICP lead to in SDH if left untreated?

A

Herniation and brainstem death

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15
Q

What do the majority of SDH occur due to?

A

Trauma

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16
Q

Can SDH occur in the absence of trauma?

A

Yes, often as chronic SDHs

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17
Q

What are the risk factors for SDH?

A
  • Increasing age
  • Alcohol excess
  • Epileptics
  • Clotting disorders or on anticoagulation’s
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18
Q

Why is increasing age a risk factor for SDH?

A

Bridging veins become more vulnerable to tears due to brain atrophy, which causes stretching of these veins

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19
Q

Why is epilepsy a risk factor for SDH?

A

Prone to falls and head injuries

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20
Q

What are the clinical features of SDH?

A
  • Altered level of consciousness
  • Headaches
  • Focal neurological signs
  • Features of raised ICP
  • Seizure activity
21
Q

What features of raised ICP may be present in SDH?

A
  • Blurred vision

- Worsening headache

22
Q

How do the symptoms vary between acute and chronic SDH?

A

Symptoms of acute SDH occur quickly, whereas those with chronic SDH have a latent period of weeks or even months before symptoms appear

23
Q

What is important to do when children present with SDH?

A

Survey for other injuries with suspected SDH

24
Q

Why is it important to survey for other injuries when children present with SDH?

A

May be signs of non-accidental injury

25
Q

What routine bloods should be done in SDH?

A
  • FBC
  • CRP
  • U&Es
  • LFTs
  • Clotting
  • G&S
26
Q

What is the gold standard imaging modality for suspected SDH?

A

Non-contrast CT scan of head

27
Q

What does a non-contrast CT scan of the head show in SDH?

A

Crescent-shaped collection of blood over one hemisphere, with or without associated midline shift

28
Q

Why might SDH appear different on CT scanning?

A

Depending on time of presentation

29
Q

How does acute SDH appear on CT scanning?

A

Diffusely hyper dense

30
Q

How does subacute SDH appear on CT scanning?

A

Heterogenously hyperdense or isodense

31
Q

How does chronic SDH appear on CT scanning?

A

Diffusely hypodense

32
Q

How does acute-on-chronic SDH appear on CT scanning?

A

Areas of hyperdensity within a hypodense haematoma

33
Q

What are the differential diagnoses for acute SDH?

A
  • Extradural haemorrhage
  • Subarachnoid haemorrhage
  • Intracerebral haemorrhage
  • Infarction
34
Q

What are the differential diagnoses for chronic SDH?

A
  • SOL, e.g. tumor or abscess
  • Meningitis or encephalitis
  • Dementia
35
Q

What approach should be taken to SDH in an acute setting?

A

Systematic A-E assessment, with any concerns of raised ICP being managed appropriately

36
Q

What should be done if a patient presenting with SDH is on anticoagulants?

A

They should be reversed appropriately

37
Q

What might the reversal of anticoagulation of patients presenting with SDH require?

A

Discussion with haematology

38
Q

What medication are patients with SDH often started on?

A

Anti-epileptics

39
Q

How long are patients on anti-epileptic medications after SDH?

A

1 week

40
Q

What should happen in patients who have had SDH following a fall?

A

They should be investigated for potential underlying reasons for falls

41
Q

What may be required in the investigation for underlying reasons for falls?

A

MDT approach with input from geriatricians, physiotherapists, and occupational therapists

42
Q

What should the management of SDH be based on?

A

Size and clinical features

43
Q

When is conservative management appropriate for SDH?

A

Small acute SDH that do not cause significant midline shift or cisternal encroachment, without significant neurologic impairment

44
Q

What management options may be used for acute SDHs requiring surgical intervention?

A
  • Trauma craniotomy

- Hemicraniectomy

45
Q

When might a hemicraniectomy be used in acute SDH?

A

If there is significant cerebral swelling or associated contusions

46
Q

What might be involved in the management of chronic SDH?

A
  • Burr hole craniotomy with irrigation

- Twist drill craniotomy with drain placement

47
Q

Why is a drain used in chronic SDH?

A

Shown to decrease recurrence rates and mortality without increasing complications

48
Q

What are the complications of SDH?

A
  • Cerebral oedema and raised ICP
  • Seizures
  • Herniation
  • Persistent vegetative state
  • Permanent neurological or cognitive deficits
  • Recurrent haematoma formation

A - MSRA Neuro and Stroke [12] (33 decks)

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