Subdural and Epidural Hematomas

Question 1

describe subdural hematoma

Answer 1

tearing of bridging veins between brain and dural sinuses; accumulation of blood; compression of brain tissue leads to lesions and decreased consciousness

Question 2

chronic subdural hematoma

Answer 2

SDH that is more than 20 days old

Question 3

describe epidural hematoma

Answer 3

meningeal A in perisoteal layer of dura are torn; bleeding between periosteum and skull; compression of brain

Question 4

is SDH or EDH a medical emergency

Answer 4

EDH - extensive pooling of blood can lead to death

Question 5

SDH s/s

Answer 5

decreased consciousness
HA
difficulty with gait/balance
cognitive dysfunction
memory loss
personality changes
motor deficits
aphasia

Question 6

EDH s/s

Answer 6

HA
N/V
seizures
focal neurological deficits (visual field cuts, aphasia, weakness, numbness)

Question 7

prevalance SDH

Answer 7

20/100,000
peak 6-7th decade
80% in elderly men

Question 8

prevalence EDH

Answer 8

40,000 cases/yr

Question 9

etiology SDH

Answer 9

• shearing of veins during acc/deceleration of brain
• MVA, falls, violence
• anticoagulation meds increase risk

Question 10

etiology EDH

Answer 10

• 85-95% from skull fx
• make up 2% of all head traumas
• alcohol associated with increased risk
• infection/abscess, coagulopathy, hemorrhagic tumors, vascular malformations

Question 11

dx SDH/EDH

Answer 11

CT or MRI
blood test to assess clotting ability of blood

Question 12

any elderly individual complaining of HA and changes in mental function should be screened for

Answer 12

SDH/EDH

Question 13

PT examination

Answer 13

• neuro exam
• findings: loss of consciousness, U/L diminished DTR, abnormal pupillary light reflex, U/L mm weakness, U/L sensation loss, changes in gait

Question 14

maintence/prevention hematomas

Answer 14

• testing to clear for RTS
• educate on helmets and seat belts
• fall prevention

Question 15

PT POC

Answer 15

early mobilization
gait training
functional training
ROM
balance/postural activities
strengthening

Question 16

tx hematomas

Answer 16

• craniotomy
• EDH - trephination (burr holes)
• if not surgical –> monitor every 6-8 hours and observe for any neurological changes
• meds: atorvostatin, tranexamic acid, dexamethosone

Question 17

mortality rate SDH/EDH

Answer 17

SDH: 50-90%
EDH: 5-50% (major deficits)

Question 18

PT diff dx

Answer 18

EDH: alcohol related neuropathy, anisocoria, AS, intracranial hemorrhage, SP hemorrhage, TIA

SDH: dementia, stroke, TIA, tumor, subarchnoid hemorrhage, meningitis, encephalitis