Haemorrhagic Stroke: Subdural Flashcards

1
Q

Definition

A

Subdural haemorrhage occurs when blood accumulates between the dura and arachnoid mater (subdural space), forming a collection known as a subdural haematoma (SDH).

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2
Q

Epidemiology/ Risk factors

A

Age: older patients = chronic SDH
MC = Px have a small brain
- alcoholics
- dementia
- babies that have suffered trauma
* making bridging veins more vulnerable *
Coagulopathy or anti coagulation medication

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3
Q

Aetiology

A

Rupture of bridging cortical vein due to shearing. Deceleration injuries and in abused children (shaken baby syndrome)
Acute = < 3 days old
- Due to trauma
Chronic = > 21 days old
- Associated with cortical atrophy e.g elderly or alcoholics
- Bridging veins are more prone to rupture with cortical atrophy
- Requires lower impact trauma compared to acute
- Because, there is cortical atrophy, subdural space is larger, these haematomas can enlarge significantly over time whilst patients remain asymptomatic

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4
Q

Pathophysiology

A

Trauma either due to deceleration, violent injury or due to dural metastases resulting in bleeding from bridging veins between the cortex + venous sinuses
Bridging veins bleeding + form a haematoma between dura + arachnoid = this reduces pressure + bleeding stops.
Days/weeks later the haematoma starts to autolyse due to the massive increase in chronic + osmotic pressure thus water is sucked into the haematoma resulting in haematoma enlarging = gradual rise in intra-cranial pressure (ICP) over many weeks
Shifting midline structures away from the side of the clot + if untreated leads to eventful tectorial herniation + coning (brain herniates through foramen magnum - causes significant damage).

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5
Q

Acute Subdural haemorrhage Signs

A
  • Symptom onset within 3 days of inciting event
  • May have a lucid interval
  • Reduced consciousness (fluctuating GCS)
  • Headaches + vomiting
  • Slurred speech
  • Focal neurological deficit e.g. weakness or fixed dilated pupil, CN3 palsy
  • CUSHING’S TRIAD: bradycardia, widened pulse pressure + irregular breathing
  • Seizures
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6
Q

Chronic Subdural Haemorrhage Signs

A
  • Insidious onset usually in the elderly or alcoholics
  • Progressive confusion and cognitive deficit
  • Headaches and vomiting
  • Focal neurological deficit e.g. weakness or fixed dilated pupils
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7
Q

Investigations

A

FIRST LINE = Non-contrast CT head: CRESCENT collection around the surface of the brain which is not limited by the suture lines of the skull unlike an extradural haemorrhage + Midline shift or herniation
- Acute = hyper-dense (bright)
- Subarachnoid = hypo-dense (dark)

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8
Q

Treatment

A

BURR HOLES + craniotomy
Non surgical = IV Mannitol to reduce ICP

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9
Q

Complications

A

Brain stem herniation

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