Subdural Haemorrhage

Question 1

What are RF for subdural haemorrhage?

Answer 1

1. Vit K antagonist
2. Factor Xa or antiplatelet agents
3. Direct thrombin inhibitors
4. Advanced age >65 years
5. Recent trauma

Question 2

What are the causes of subdural haemorrhage?

Answer 2

1. Trauma

2. Vascular malformation (i.e. AV malformation or dural fistula)

Question 3

What is classic epid of subdural haemorrhage?

Answer 3

Chronic in older people with Hx of falls or anticoagulant use

Question 4

What are symptoms of subdural haemorrhage?

Answer 4

1. Headache
2. Nausea/vomiting
3. Diminished eye response
4. Diminished verbal response
5. Diminished motor response
6. Confusion
7. Peronsality change

Question 5

What are some signs of a subdural haemorrhage?

Answer 5

1. Raised ICP

2. Seizures

Question 6

What are possible DDx of subdural haemorrhage?

Answer 6

1. Epidural haematoma
2. Intracerebral haematoma
3. Diffuse axonal injury
4. Stroke
5. Seizure
6. Substance abuse

Question 7

What investigations are used for subdural haemorrhage?

Answer 7

• Non-contrast CT head: subdural fluid collection

- Cresent shape collection of bloods (banana)

Question 8

What is the management of subdural haemorrhage in the aftermath?

Answer 8

1 week of antiepileptic therapy e.g. phenytoin, levetiracetam) considered in acute and acute on chronic SH

Question 9

What is the acute treatment of <10 mm size: midline shift <5 mm non-expansile without significant neurological dysfunction?

Answer 9

• 1st line: observation, monitoring, follow up imaging
• prophylactic antiepileptics e.g.. phenytoin 10-20mg/Kg
• Correct of coagulopathy
• ICP lowering regimen

Question 10

What is the acute treatment of subdural haemorrhage ≥10 mm size or midline shift >5 mm or expansile or significant neurological dysfunction?

Answer 10

1st line: surgery + monitoring + prophylactic antiepileptics

• correction of coagulopathy
• ICP pressure-lowering regimen

Question 11

What surgery is possible?

Answer 11

burr holes or craniotomy

Question 12

What is the management of subdural haemorrhage with ventriculoperitoneal shunt?

Answer 12

1st line: adjustment of shunt drainage + other measures as indicated

Question 13

What is the treatment of chronic haematoma?

Answer 13

1st line: antiepileptics

• elective surgery
• correction of coagulopathy
• ICP lowering regimen

Question 14

What are possible complications of subdural haemorrhage?

Answer 14

1. Early or delayed reaccumalation of subdural haematoma
2. Seizures
3. Vascular injury to cortical veins and arteries
4. Strokes
5. Persistent neurological deficit
6. Coma
7. Death

Question 15

What is a subdural haemorrhage?

Answer 15

collection of blood between the dura and arachnoid meningeal layers

Question 16

What is classic epi for subdural haemorrhage?

Answer 16

elderly, alcoholics

Question 17

What is the patho for subdural haemorrhage?

Answer 17

1. Rupture of bridging veins

2. Subdurals may follow minor trauma up to 9 weeks prior which patients may have forgotten

Question 18

What is an acute subdural haemorrhage?

Answer 18

Within 72 hours (younger patients, trauma)

Question 19

What is a subacute subdural haemorrhage?

Answer 19

3-20 days (worsening headache, elderly)

Question 20

What is a chronic subdural haemorrhage?

Answer 20

After 3 weeks (headache, confusion)