Subdural haematoma Flashcards
In subdural haematoma which layers become separated?
The meningeal layer of the dura, and the arachnoid mater
Aetiology of subdural haemorrhage?
Trauma- shearing of bridging veins which travel from the cortex to the dura mater
History of acute SDH (2)
Trauma with head injury; altered conscious level
History of subacute SDH (2)
Worsening headaches 7-14 days after injury, altered mental status
Chronic history of SDH (5)
Headache; confusion; cognitive impairment; focal weakness; seizures
In whom should you have a low index of suspicion for SDH? (2)
Elderly; alcoholics
Why might an ipsilateral fixed dilated pupil be seen?
Large haematomas can result in a midline shift, compressing the parasympathetic fibres of the third nerve
Describe CT findings in SDH
Crescent or sickle-shaped mass; extensive (not limited by skull sutures)
Describe how the density of SDHs changes over time (3)
Acute- hyperdense
Subacute- isodense
Chronic- hypodense
When might MRI be used in the context of suspected SDH?
To attain higher sensitivity, particularly for isodense (subacute) or small SDHs
What can chronic subdural haemorrhage be confused with?
Dementia due to neurodegeneration
Surgical management of symptomatic SDH
Burr hole, or craniotomy + drainage
Potential complications of SDH (2)
Raised ICP leading to herniation
Cerebral oedema predisposing to ischaemia;
Post-op complications of SDH (3)
Seizures
Recurrence (up to 30%)
Brain abscess or meningitis
