Subdural Haemorrhage Flashcards
What is a subdural haemorrhage (SDH)?
It is an intracranial haemorrhage within the subdural space, which is located between the dura mater and arachnoid mater of the brain
What are the three classifications of subdural haemorrhage?
Acute Subdural Haemorrhages
Subacute Subdural Haemorrhages
Chronic Subdural Haemorrhages
What is an acute subdural haemorrhage?
It is defined as a collection of blood within the subdural space that has been present for less than 3 days
What is a subacute subdural haemorrhage?
It is defined as a collection of blood within the subdural space that has been present for a period of 3 – 21 days
What is a chronic subdural haemorrhage?
It is defined as a collection of blood within the subdural space that has been present for more than 21 days
Which vessels are most commonly associated with subdural haemorrhages?
The bridging cranial veins in the outermost meningeal layer, between the cortex and venous sinus
What is the most common cause of subdural haemorrhages?
It is usually related to head trauma to the temporal region of the head
What are the four risk factors associated with subdural haemorrhages?
Older Age > 65 Years Old
Falls
Alcoholism
Anticoagulant Administration
What are the eight clinical features of subdural haemorrhages?
Headache
Nausea & Vomiting
Drowsiness
Confusion
Seizures
Loss of Consciousness
Poor Balance
Paraesthesia
What is a key clinical feature of subdural haematoma?
Fluctuating confusion/consciousness
What is the gold standard investigation used to diagnose subdural haemorrhages?
Non-Contrast CT scans
What are the four features of subdural haemorrhages on CT scans?
Crescent Shaped Mass
Non-Limitation of Mass to Suture Lines of Skull
Midline Shift
Brainstem Herniation
How do acute subdural haemorrhages appear on CT scans?
Hyperdense - bright white
How do chronic subdural haemorrhages appear on CT scans?
Hypodense - dark grey/black
What are the three initial management options of subdural haemorrhages?
ABCDE Approach
Coagulation Correction
Anticonvulsant Medications
What coagulation correction is recommended in subdural haemorrhages?
In cases where individuals are on anticoagulants, they should receive reversal agents to prevent further bleeding
OR
In cases where individuals have coaguloapathy, haematology advice is required to determine whether transfusions are required
Why are anticonvulsants used to manage subdural haemorrhages?
They reduce the risk of seizure development
Name two anticonvulsants used to manage subdural haemorrhages
Levitracetam
Phenytoin
When do we recommend conservative management of subdural haemorrhages?
Small haemorrhages with no neurological deficits
How do we conservatively management subdural haemorrhages?
Clinical and radiological observation
What are the two surgical management options of subdural haemorrhages?
Craniotomy
Burr Hole Craniotomy
When are craniotomies used to manage subdural haemorrhages?
It is the first line surgical management option used to manage acute subdural haemorrhages
What is craniotomy?
It involves surgical removal of a skull section, with evacuation of the haematoma and ligation of the ruptured blood vessel
When is burr hole craniotomy used to manage subdural haemorrhages?
It is the first line surgical management option used to manage chronic subdural haemorrhage
What is burr hole craniotomy?
It involves formation of a small hole within the skull
This enables insertion of a suction tube to evacuate the haematoma
What are the three complications of subdural haemorrhages?
Recurrent Subdural Haematoma
Intracranial Infection
Seizures
