SDH Flashcards
def
bleeding or a collection of blood between the dura mater and arachnoid mater
aetiology
commonly trauma which occurred long ago or was so minor it is forgotten
trauma often causes a rapid acceleration-deceleration injury which results in shearing of the ‘bridging veins’
non-trauma causes include reduced ICP and dural metastases
epi
acute - more common in younger patients with head trauma
chronic - more common in elderly
history
characteristic is a headache, fluctuating level of consciousness with or without an insidious physical or mental slowing, and unsteadiness
acute
-history of head trauma and reduced consciousness
subacute
-worsening headache 1-2wks post head trauma
chronic
-headaches, confusion
-gait deterioration + focal weakness
what are the risk factors or associations of SDH
age
alcoholism (falls)
anticoagulation
examination
acute
-reduced GCS
-raised ICP (worse on coughing + leaning forward)
-large haematomas cause
chronic
-focal neurological signs (unequal pupils, hemiparesis)
investigations
CT head
- crescent-shaped mass over brain surface, acute subdurals are hyperdense and appear white, subacute are isodense and appear a light grey colour, chronic are hypodense and appear black
- may also see midline shift
management
acute
-ABCDEFG
-if signs of raised ICP, elevate the head and consider IV mannitol +/ hyperventilation
-once stable, obtain CT-head
conservative treatment for asymptomatic (small) SDHs
surgical approach for symptomatic (large) SDHs
-wash out or remove the blood using a burr twist drill and burr hole craniostomy, this is considered first line
-craniotomy is second line
complications
raised ICP + cerebral oedema pre-dispose to secondary ischaemic damage or tentorial herniation and coning
seizures + meningitis are common post surgery
prognosis
chronic SDH has better prognosis than acute SDH
