Subdural Haemorrhage

Question 1

What is a subdural haemorrhage (SDH)?

Answer 1

It is an intracranial haemorrhage within the subdural space, which is located between the dura mater and arachnoid mater of the brain

Question 2

What are the three classifications of subdural haemorrhage?

Answer 2

Acute Subdural Haemorrhages

Subacute Subdural Haemorrhages

Chronic Subdural Haemorrhages

Question 3

What is an acute subdural haemorrhage?

Answer 3

It is defined as a collection of blood within the subdural space that has been present for less than 3 days

Question 4

What is a subacute subdural haemorrhage?

Answer 4

It is defined as a collection of blood within the subdural space that has been present for a period of 3 – 21 days

Question 5

What is a chronic subdural haemorrhage?

Answer 5

It is defined as a collection of blood within the subdural space that has been present for more than 21 days

Question 6

Which vessels are most commonly associated with subdural haemorrhages?

Answer 6

The bridging cranial veins in the outermost meningeal layer, between the cortex and venous sinus

Question 7

What is the most common cause of subdural haemorrhages?

Answer 7

It is usually related to head trauma to the temporal region of the head

Question 8

What are the four risk factors associated with subdural haemorrhages?

Answer 8

Older Age > 65 Years Old

Falls

Alcoholism

Anticoagulant Administration

Question 9

What are the eight clinical features of subdural haemorrhages?

Answer 9

Headache

Nausea & Vomiting

Drowsiness

Confusion

Seizures

Loss of Consciousness

Poor Balance

Paraesthesia

Question 10

What is a key clinical feature of subdural haematoma?

Answer 10

Fluctuating confusion/consciousness

Question 11

What is the gold standard investigation used to diagnose subdural haemorrhages?

Answer 11

Non-Contrast CT scans

Question 12

What are the four features of subdural haemorrhages on CT scans?

Answer 12

Crescent Shaped Mass

Non-Limitation of Mass to Suture Lines of Skull

Midline Shift

Brainstem Herniation

Question 13

How do acute subdural haemorrhages appear on CT scans?

Answer 13

Hyperdense - bright white

Question 14

How do chronic subdural haemorrhages appear on CT scans?

Answer 14

Hypodense - dark grey/black

Question 15

What are the three initial management options of subdural haemorrhages?

Answer 15

ABCDE Approach

Coagulation Correction

Anticonvulsant Medications

Question 16

What coagulation correction is recommended in subdural haemorrhages?

Answer 16

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

Question 17

Why are anticonvulsants used to manage subdural haemorrhages?

Answer 17

They reduce the risk of seizure development

Question 18

Name two anticonvulsants used to manage subdural haemorrhages

Answer 18

Levitracetam

Phenytoin

Question 19

When do we recommend conservative management of subdural haemorrhages?

Answer 19

Small haemorrhages with no neurological deficits

Question 20

How do we conservatively management subdural haemorrhages?

Answer 20

Clinical and radiological observation

Question 21

What are the two surgical management options of subdural haemorrhages?

Answer 21

Craniotomy

Burr Hole Craniotomy

Question 22

When are craniotomies used to manage subdural haemorrhages?

Answer 22

It is the first line surgical management option used to manage acute subdural haemorrhages

Question 23

What is craniotomy?

Answer 23

It involves surgical removal of a skull section, with evacuation of the haematoma and ligation of the ruptured blood vessel

Question 24

When is burr hole craniotomy used to manage subdural haemorrhages?

Answer 24

It is the first line surgical management option used to manage chronic subdural haemorrhage

Question 25

What is burr hole craniotomy?

Answer 25

It involves formation of a small hole within the skull

This enables insertion of a suction tube to evacuate the haematoma

Question 26

What are the three complications of subdural haemorrhages?

Answer 26

Recurrent Subdural Haematoma

Intracranial Infection

Seizures