Subdural Haemorrhage Flashcards
What is a subdural haemorrhage?
a collection of blood between the dura + arachnoid mater
(Extra-axial as blood not within substance of brain)
What is the aetiology of subdural haemorrhage?
Trauma causing rapid acceleration + deceleration of the brain results in shearing forces which tear “bridging veins” between dura + cortex
Name a less common cause of subdural haematoma
Rupture of a cerebral aneurysm or AV malformation
How does size of acute vs chronic SDH differ?
Because of brain atrophy there is considerable room for chronic SDH’s to enlarge before causing Sx
Describe the classification of subdural haemorrhages
ACUTE: < 72h. Rapid neurological deterioration
SUBACUTE: 3- 20 days. Gradual Sx progression
CHRONIC: > 3w. May not recall head injury
What is the epidemiology of subdural haemorrhage?
Acute: younger patients/ a/w major trauma
MORE COMMON than EDH
Chronic: more common in ELDERLY
Descirbe the typical presentation of SDH
Hx of head trauma (minor to severe)
Frequently exhibit lucid interval followed by gradual decline in consciousness (esp. in chronic)
Headache, confusion + lethargy
List 4 symptoms of SDH
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)
List 5 physical examination findings in SDH
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.
List 3 behavioural and cognitive changes in SDH
Memory Loss: esp. in chronic SDH.
Personality Changes: Irritability, apathy, or depression.
Cognitive Impairment: Difficulty with attention, problem-solving, + other executive functions.
What is the first line investigation for subdural haemorrhage? What will be seen?
Non-contrast CT Head
Crescentic collection not limited by suture lines
If large, mass effect will cause midline shift/ herniation
How does CT appearance differ depending on age of SDH?
Acute: diffusely HYPERdense
Subacute: heterogeneously hyperdense/ isodense
Chronic: diffusely HYPOdense
Acute-on-chronic: areas of hyperdensity within hypodense haematoma
Describe management for acute subdural haemorrhage <10mm
Obs, monitoring + f/u imaging
Prophylactic antiepileptics
+/- correction of coagulopathy
+/- ICP Mx
Describe management for acute subdural haemorrhage >10mm
Surgery
Monitoring
Prophylactic anti epileptics
+/- correction of coagulopathy
+/- ICP Mx
Describe surgical intervention for SDH
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
What are the treatment options for chronic subdural haemorrhage?
Antiepileptics
If symptomatic: Burr hole craniotomy + irrigation or twist drill craniotomy + drain placement
If asymptomatic: conservative, serial imaging
What are 3 complications of subdural haemorrhage?
Raised ICP
Cerebral oedema
Herniation
What is the prognosis for acute subdural haemorrhage?
Underlying brain injury will affect function
What is the prognosis for chronic subdural haemorrhage?
Better outcome than acute subdural haemorrhages
Lower incidence of underlying brain injury
What treatment my be used in children with subdural haemorrhage?
Percutaneous aspiration via an open fontanelle
Why should you have a low index of suspicion of chronic SDH in the elderly + alcoholics?
They have brain atrophy + therefore fragile or taut bridging veins
Describe the appearance of subdural haemorrhage on CT
Crescent/ sickle shaped mass
Concave over brain surface
“Banana shaped”
List 4 post-op complications of subdural haemorrhage
Seizures
Recurrence
Surgical site infection
Neurological deficits
