Subdural haemorrhage Flashcards
Define a subdural haemorrhage
Accumulation of blood between the arachnoid and dura mater, usually due to the
rupture of a vein. Can be acute or chronic.
What is the epidemiology and RFs for subdural haemorrhage?
- More common in elderly and alcoholics (brain atrophy and increased falls)
- Most due to trauma
- Anticoagulation
What is subdural haemorrhage seen in?
Abused children (shaken baby syndrome)
Describe the pathophysiology of a subdural haemorrhage
- Bleeding from bridging veins into subdural space
- Forms a haemotoma (clot) which stops the bleeding
- Weeks/months later the clot autolyses – clot draws water in and expands
- Gradual increase in ICP Midline shift Herniation and coning Coma + Death
What are the symptoms of subdural haemorrhage?
Gradual onset with latent period, with accumulation of blood, symptoms arrive after days/ weeks/ months
- Fluctuating consciousness
- Drowsiness
- Headache
- Confusion
- Behavioral change
- Signs of ICP – vomiting, nausea, seizure, raised BP
- Coma – many present with this
How do you diagnose subdural haemorrhage?
- CT head –
Acute: Hyperdense (lighter) crescent shape
Chronic: Hypodense (darker) crescent shape
Acute on chronic: may be both
What is the differential diagnosis for subdural haemorrhage?
- Stroke
- Dementia
- Mass lesion
What is the treatment for subdural haemorrhage?
- Starts with basics – ABCDE, Start oxygen, Maintain systolic BP >90 mmHg
Neurosurgery: - Burr hole – irrigation + evacuation
- Craniotomy – to reduce ICP acutely
- Address cause for fall – arrhythmias, cataracts
- IV mannitol – reduce ICP
How do you remember the shape of subdural haemorrhage on CT?
suB = banana
So crescent shaped CT
