Subdural Haemorrhage

Question 1

What is a Subdural Haematoma?

Answer 1

Collection of blood in in subdural space following rupture of a vein
Usually post head injury, can occur spontaneously

Question 2

What are the two main types of subdural haematoma?

Answer 2

Acute

Subacute/spontaneous

Question 3

When do acute subdural haematomas typically occur?

Answer 3

Occur in severe-acceleration deceleration head injury, often w/ co-existing brain damage
Young pts

Question 4

How do acute subdural haematomas typically present?

Answer 4

Dilated pupil
Non lucid
Decreased GCS

Question 5

What are the key elements of managing acute subdural haematomas?

Answer 5

ABCDE resus
Craniotomy & early evacuation of clot
ICU admission w/ intracranial pressure monitoring

Question 6

What are the common complications of acute subdural haematomas?

Answer 6

Epilepsy
Permanent neurological disability
High mortality

Question 7

When do subacute/spontaneous subdural haematomas typically occur?

Answer 7

Spontaneously/after minor trauma

Can be bilateral

Question 8

What are the risk factors for subacute/spontaneous subdural haematomas?

Answer 8

Age (cortical atrophy stretches brittle veins)
Alcohol abuse
Coagulopathies

Question 9

What are the sx/signs of raised ICP?

Answer 9

Headache
Drowsiness
Confusion
Focal neurological signs
Stupor/coma

Question 10

How should subacute/spontaneous subdural haemorrhage be managed?

Answer 10

Liaise w/ neurosurgeon

Chronic subdural haemorrhage may resolve spontaneously

Question 11

What imaging modality is used to assess subdural haemorrhage?

Answer 11

CT

Question 12

What is the appearance of an acute subdural haematoma on CT?

Answer 12

Crescenteric shape w/ increased density, conforming to contour of skull
Midline shift
Ventricular compression

Question 13

What is the apperance of a chronic subdural haematoma on CT?

Answer 13

Blood becomes radiolucent (dark), assumes a lentiform shape (sim to extradural)