Subdural Haematoma

Question 1

Subdural Haematoma Definition

Answer 1

• Acute
• Subacute (3-7 days after injury)
• Chronic (2-3 weeks after injury)
• Simple is no parenchymal injury
• Complicated is with underlying parenchymal injury

Question 2

Subdural Haematoma Pathophysiology

Answer 2

• Usually venous cause
• Tearing of bridging veins from cortex to venous sinus e.g. rapid acceleration-deceleration causing shearing
• Bleeding from damaged cortical artery
• Blunt head trauma is usual mechanism of injury
• Spontaneous can arise from clotting disorder, malformations or other conditions
• In subacute phase, clotted blood liquefies, in chronic phase, becomes collection of serous fluid
• Infants, elderly and those with alcoholism are at risk (alcoholism leads to thrombocytopenia and cerebral atrophy)

Question 3

Subdural Haematoma Epidemiology

Answer 3

-Occurs in 1/3 of severe head injury

Question 4

Subdural Haematoma Presentation

Answer 4

Acute

• Usually after moderate to severe head injury
• Loss of consciousness may occur
• May be lucid interval of a few hours then deterioration as haematoma grows

Chronic

• 2-3 weeks following trauma
• Initial injury may be trivial
• Gradually progressive symptoms
• Anorexia, nausea, vomiting
• If accompanying and progressive headache, should raise suspicion
• Especially in context of coagulopathy, anticoagulant use or alcohol misuse

Examination
-GCS, obs, neuro exam

Question 5

Subdural Haematoma Differentials

Answer 5

• Non-accidental injury
• SAH
• Intracerebral haemorrhage or infarction
• Meningitis/encephalitis

Question 6

Subdural Haematoma Ix

Answer 6

Bloods

• FBC, U&Es, LFTs for alternative cause of reduced consciousness
• Coag screen
• Group and save

Imaging
-CT

Question 7

Subdural Haematoma Management

Answer 7

• Surgery
• Supportive care if no neurological signs, haematoma <10mm, midline shift <5mm
• Phenytoin
• Correct coagulopathy
• Reduce ICP