Subdural Haematoma Flashcards
Who is most susceptible and why?
Elderly due to brain atrophy
What is the most common cause?
Trauma
Why can cause be hard to find?
Patient may have forgotten trauma as it could’ve been very minor or a while ago
What are some risk factors?
Falls (epileptics/alcoholics/elderly), anticoagulation, age (elderly or babies), brain atrophy (dementia/elderly/alcoholics),
How does SDH start?
Bleeding from bridging veins between cortex and venous sinuses
What happens after bleeding starts?
Blood accumulates between dura and arachnoid, ICP gradually rises, midline structures shifted away from side of the clot
What can happen if untreated?
Tentorial herniation and coning
What are some symptoms?
Fluctuating level of consciousness +/- physical or intellectual slowing, sleepiness, headache, confusion
What are some signs?
Increased ICP, seizures, localising neurological symptoms occur later
What will a CT show?
The clot +/- midline shift, prominent sulci on the opposite side to the clot
What will the clot look like?
A crescent-shape over 1 hemisphere that crosses suture lines
What are some differential diagnoses?
Stroke, dementia, CNS masses
What does surgical management depend on?
Size of clot, chronicity, clinical picture
Generally, what clots need evacuating?
> 10mm or midline shift >5mm
How can SDHs be evacuated?
Craniotomy or burr hole washout
