Sub Dural Haematoma Flashcards
What is SDH
Ruptured bridging vein causing a bleed into the Sub dural space
Where are the bridging veins found
Between cortex and Venous sinus
What is a common patient found with SDH
Elderly with minor trauma
Baby with “shaking baby”
What are the causes of SDH
Head trauma
Shaking baby syndrome
Dural metastasis
What are the risk factors for SDH
Shaking baby syndrome Atrophic brain (Increase vein rupture) -Dementia/elderly -Alcoholics Anticoagulants Trauma
What is the pathology of SDH
Bridging vein bleeds into subdural space Haematoma is formed Haematoma autolyses (Increased osmotic pressure makes it bigger) ICP rises Midline shift occurs -Tentorial herniation and Coning
What is tentorial herniation
Brain tissue movement into wrong compartment
What is coning
Chronic tentorial herniation with brainstem compression ->coma
What are the symptoms of SDH
Lapse in conscious
Drowsy
Headache
Intellectual slowing (Cant remember the trauma)
What are the signs of SDH
Raised ICP -Cushing's triad -GCS Fluctuates -Papilloedema Seizures Local Neuro signs (CN3) -Unequal pupils -Hemiparesis
What investigations would you do for SDH
CT (Banana)
MRI
What would a CT for SDH show
Banana “crescent” shaped haematoma
Crosses the suture lines
Midline shift visible
What does a hyper dense Haematoma on CT indicate
It is acute
within 3 days
What does a hypodense haematoma on CT indicate
It is chronic
over 3 weeks
Why is it difficult to see SDH in a sub acute setting (3 days to 3 weeks)
Isodense haematoma merges with the surrounding cortex
Contrast CT/MRI needed to diagnose
What factors does surgical choice depend on (CCC)
Clot size
Chronic?
Clinical picture
What is the first line management for SDH
Burr hole washout
What is the 2nd line management for SDH
Craniotomy
-Haematoma resection
What drug can be given for SDH
IV Mannitol
-Decrease ICP and reverse clotting abnormalities
list the managments of SDH
Burrhole washout
Craniotomy
IV Mannitol
Why may SDH present with a latent period
Small bleed accumulates as blood autolyses
What is the Cushing’s triad in SDH
Bradycardia
Increased Partial pressure
Irregular breathing
