Subdural Haemorrhage Flashcards

1
Q

What is a subdural haemorrhage?

A

a collection of blood between the dura + arachnoid mater
(Extra-axial as blood not within substance of brain)

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2
Q

What is the aetiology of subdural haemorrhage?

A

Trauma causing rapid acceleration + deceleration of the brain results in shearing forces which tear “bridging veins” between dura + cortex

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3
Q

Name a less common cause of subdural haematoma

A

Rupture of a cerebral aneurysm or AV malformation

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4
Q

How does size of acute vs chronic SDH differ?

A

Because of brain atrophy there is considerable room for chronic SDH’s to enlarge before causing Sx

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5
Q

Describe the classification of subdural haemorrhages

A

ACUTE: < 72h. Rapid neurological deterioration
SUBACUTE: 3- 20 days. Gradual Sx progression
CHRONIC: > 3w. May not recall head injury

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6
Q

What is the epidemiology of subdural haemorrhage?

A

Acute: younger patients/ a/w major trauma
MORE COMMON than EDH
Chronic: more common in ELDERLY

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7
Q

Descirbe the typical presentation of SDH

A

Hx of head trauma (minor to severe)
Frequently exhibit lucid interval followed by gradual decline in consciousness (esp. in chronic)
Headache, confusion + lethargy

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8
Q

List 4 symptoms of SDH

A

Altered mental status: drowsiness + mild confusion to stupor + coma
N+V: secondary to raised ICP
Headache: often unilateral, worsening over time
Seizures (esp. if acute or expanding)

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9
Q

List 5 physical examination findings in SDH

A

Cushing’s triad: bradycardia, HTN, irregular respiration
Papilloedema: raised ICP
Pupil Changes: Ipsilateral fixed dilated pupil, indicating compression of CN3
Gait Abnormalities: Inc. ataxia or weakness in one leg.
Hemiparesis or Hemiplegia: mass effect + midline shift.

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10
Q

List 3 behavioural and cognitive changes in SDH

A

Memory Loss: esp. in chronic SDH.
Personality Changes: Irritability, apathy, or depression.
Cognitive Impairment: Difficulty with attention, problem-solving, + other executive functions.

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11
Q

What is the first line investigation for subdural haemorrhage? What will be seen?

A

Non-contrast CT Head
Crescentic collection not limited by suture lines
If large, mass effect will cause midline shift/ herniation

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12
Q

How does CT appearance differ depending on age of SDH?

A

Acute: diffusely HYPERdense
Subacute: heterogeneously hyperdense/ isodense
Chronic: diffusely HYPOdense
Acute-on-chronic: areas of hyperdensity within hypodense haematoma

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13
Q

Describe management for acute subdural haemorrhage <10mm

A

Obs, monitoring + f/u imaging
Prophylactic antiepileptics
+/- correction of coagulopathy
+/- ICP Mx

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14
Q

Describe management for acute subdural haemorrhage >10mm

A

Surgery
Monitoring
Prophylactic anti epileptics
+/- correction of coagulopathy
+/- ICP Mx

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15
Q

Describe surgical intervention for SDH

A

Trauma craniotomy flap
If large with significant mass effect, bone flap often left out at surgery = decompressive craniectomy
If small, bone flap replaced at end of op

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16
Q

What are the treatment options for chronic subdural haemorrhage?

A

Antiepileptics
If symptomatic: Burr hole craniotomy + irrigation or twist drill craniotomy + drain placement
If asymptomatic: conservative, serial imaging

17
Q

What are 3 complications of subdural haemorrhage?

A

Raised ICP
Cerebral oedema
Herniation

18
Q

What is the prognosis for acute subdural haemorrhage?

A

Underlying brain injury will affect function

19
Q

What is the prognosis for chronic subdural haemorrhage?

A

Better outcome than acute subdural haemorrhages
Lower incidence of underlying brain injury

20
Q

What treatment my be used in children with subdural haemorrhage?

A

Percutaneous aspiration via an open fontanelle

21
Q

Why should you have a low index of suspicion of chronic SDH in the elderly + alcoholics?

A

They have brain atrophy + therefore fragile or taut bridging veins

22
Q

Describe the appearance of subdural haemorrhage on CT

A

Crescent/ sickle shaped mass
Concave over brain surface
“Banana shaped”

23
Q

List 4 post-op complications of subdural haemorrhage

A

Seizures
Recurrence
Surgical site infection
Neurological deficits