Subdural and Epidural Hematomas Flashcards
describe subdural hematoma
tearing of bridging veins between brain and dural sinuses; accumulation of blood; compression of brain tissue leads to lesions and decreased consciousness
chronic subdural hematoma
SDH that is more than 20 days old
describe epidural hematoma
meningeal A in perisoteal layer of dura are torn; bleeding between periosteum and skull; compression of brain
is SDH or EDH a medical emergency
EDH - extensive pooling of blood can lead to death
SDH s/s
decreased consciousness
HA
difficulty with gait/balance
cognitive dysfunction
memory loss
personality changes
motor deficits
aphasia
EDH s/s
HA
N/V
seizures
focal neurological deficits (visual field cuts, aphasia, weakness, numbness)
prevalance SDH
20/100,000
peak 6-7th decade
80% in elderly men
prevalence EDH
40,000 cases/yr
etiology SDH
- shearing of veins during acc/deceleration of brain
- MVA, falls, violence
- anticoagulation meds increase risk
etiology EDH
- 85-95% from skull fx
- make up 2% of all head traumas
- alcohol associated with increased risk
- infection/abscess, coagulopathy, hemorrhagic tumors, vascular malformations
dx SDH/EDH
CT or MRI
blood test to assess clotting ability of blood
any elderly individual complaining of HA and changes in mental function should be screened for
SDH/EDH
PT examination
- 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
maintence/prevention hematomas
- testing to clear for RTS
- educate on helmets and seat belts
- fall prevention
PT POC
early mobilization
gait training
functional training
ROM
balance/postural activities
strengthening
tx hematomas
- craniotomy
- EDH - trephination (burr holes)
- if not surgical –> monitor every 6-8 hours and observe for any neurological changes
- meds: atorvostatin, tranexamic acid, dexamethosone
mortality rate SDH/EDH
SDH: 50-90%
EDH: 5-50% (major deficits)
PT diff dx
EDH: alcohol related neuropathy, anisocoria, AS, intracranial hemorrhage, SP hemorrhage, TIA
SDH: dementia, stroke, TIA, tumor, subarchnoid hemorrhage, meningitis, encephalitis
