Subdural/epidural haematoma Flashcards
What is subdural haematoma? Acute vs chronic?
A subdural haematoma is a collection of blood deep to the dural layer of the meninges.
The blood is not within the substance of the brain and is therefore called an ‘extra-axial’ or ‘extrinsic’ lesion. They can be unilateral or bilateral.
An acute subdural haematoma is a collection of fresh blood within the subdural space and is most commonly caused by high-impact trauma.
A chronic subdural haematoma is a collection of blood within the subdural space that has been present for weeks to months.
Where is bleeding from in SDH? Where does blood accumulate? Whatdoes this cause?
Bridging veins between the cortex and venous sinuses
Haematoma accumulates between the dura and arachnoid mater.
This gradually raises ICP, shifting midline structures away from the side of the haematoma and can lead to tentorial herniation and coning.
What causes SDH?
Mostly from trauma - can be minor
MEtasteses
What are risk factors for SDH?
Falls - epileptics, alcoholics
Anticoagulation
What are symptoms of SDH?
Fluctuating love of consciousness Insidious physical or intellectual slowing s Sleepiness Headache Personality change Unsteadiness
What are signs of SDH?
RICP
Seizures
Localising neurological symptoms
Occur late
What does imaging show in SDH?
CT imaging is the first line treatment and will show a crescentic collection, not limited by suture lines. They will appear hyperdense (bright) in comparison to the brain. Large acute subdural haematomas will push on the brain (‘mass effect’) and cause midline shift or herniation.
BANANA
What is management fro SDH?
Reverse clotting abnormalities
Surgical management depends on size of clot, its chronicity and the clinical picture - midline shift
Via craniotomy or burr hole washout - decompression
What is chronic subdural haematoma?
How can this be differentiated from acute subdural on CT?
A chronic subdural haematoma is a collection of blood within the subdural space that has been present for weeks to months.
Rupture of the small bridging veins within the subdural space rupture and cause slow bleeding. Elderly and alcoholic patients are particularly at risk of subdural haematomas since they have brain atrophy and therefore fragile or taught bridging veins.
Presentation is typically a several week to month progressive history of either confusion, reduced consciousness or neurological deficit.
Infants also have fragile bridging veins and can rupture in shaken baby syndrome.
On CT imaging they similarly are crescentic in shape, not restricted by suture lines and compress the brain (‘mass effect’). In contrast to acute subdurals, chronic subdurals are hypodense (dark) compared to the substance of the brain.
Cause of extradural haematoma? Where is bleeding from the EDH? Where does blood accumulate?
Traumatic head injury that initially produced no LOC
Often due to fractures temporal bone or parietal bone at the pterion causing laceration of middle meningeal artery and vein
Any tear in dural venous sinus will also results in extradural bleed
Blood accumulates between bone and dura mater
Clinical features of extradural haematoma?
Lucid interval may last a few hours to few days before Reduced GCS from RICP
Increasingly severe headache
Vomiting
Confusion
Seziures
Hemiparesis with brisk reflexes and upgoing plantar
If bleeding continues, ipsilateral pupil dilates and brainstem compression results in deep irregular breathing - Kussmaul’s
What causes death in extradural?
Respiratory arrest
What investigations in extradural? What do they show?
CT shows lemon haematoma
LP contraindicated
What is management in extradural haematoma?
Stabilise and transfer urgently to neurosurgery for clot evacuation with ligation of the bleeding vessel.
Intubation, ventilation IV mannitol
