Subdural haemorrhage

Question 1

What is a subdural haematoma

Answer 1

collection of blood deep to the dural layer of the meninges

can be unilateral or bilateral

Question 2

How are subdural haematomas classified

Answer 2

Acute - collection of fresh blood within subdural space and most commonly caused by high impact trauma

Subacute

Chronic
collection of blood within subdural space that has been present for weeks to months

Rupture of small bridging veins that causes slow bleeding

Question 3

What may someone with subdural haemorrhage present with

Answer 3

headache
evidence of trauma
nausea/vomiting
low GCS
confusion

CN III - downwards and out due to raised intracranial pressure

loss of consciousness
seizure
loss of continence
focal neurological deficits

Question 4

What are risk factors for someone with a subdural haemorrhage

Answer 4

recent trauma
anticoagulant use
advanced age

Question 5

What is the 1st investigation to order

Answer 5

Non-contrast CT scan- subdural fluid collection

Crescentic collection
Acute bleeds appear hyperdense ( bright) whereas chronic appear hypodense ( dark )

Large acute haematomas will cause midline shift or herniation

Question 6

What is the management for acute

Answer 6

if <10mm , <5mm midline shift and non-expansile without neurological dysfunction -
CONSERVATIVE MANAGEMENT

If >10mm, >5mm midline shift , expansile or neurological dysfunction -
CRANIOTOMY

Question 7

What is the management for chronic

Answer 7

Manage conservatively if small and no neurological deficit

If patient is confused, has neurological deficit or severe image findings – surgical decompression with burr holes

Question 8

What other treatment may be given

Answer 8

Antiepileptics if seizures/risk of seizures

Phenytoin/Levetiracetam