Subdural haemorrhage

Question 1

Define subdural haemorrhage.

Answer 1

A contusion or haemorrhage in the subdural space of the brain.

Question 2

Explain the aetiology / risk factors of subdural haemorrhage.

Answer 2

The primary aetiology of both acute and chronic subdural haematomas is trauma. Less commonly, subdural haematomas are associated with rupture of a cerebral aneurysm or vascular malformation (i.e., arteriovenous malformation or dural fistula). There are also case reports in the literature of spontaneous subdural haematomas associated with cerebral hypotension and malignancy.

Question 3

Summarise the epidemiology of subdural haemorrhage.

Answer 3

The exact incidence of subdural haematoma is unknown. Acute subdural haematoma is found in about 11% to 20% of patients admitted to hospital with mild to severe traumatic brain injury. Chronic subdural haematomas occur most commonly in older people (age >65 years), and are frequently associated with a history of falls or anticoagulant use.

Question 4

Recognise the presenting symptoms of subdural haemorrhage. Recognise the signs of subdural haemorrhage on physical examination.

Answer 4

Evidence of trauma
Headache
Nausea/vomiting
Diminished eye response
Diminished verbal response
Diminished motor response
Confusion

Question 5

Identify appropriate investigations for subdural haemorrhage and interpret the results.

Answer 5

Non-contrast CT scan - The subdural fluid collection is usually crescentic in shape and can cross suture lines. The age of the haematoma determines the density of the lesion. There may be effacement of the underlying sulci or midline shift, effacement of cisterns or other signs of herniation, or a skull fracture or other intracranial haematomas.

There is no advantage of using an MRI or x-ray. An MRI may be useful after surgery in order to determine the extent of ischaemia and x-ray may be used in order to identify skull fractures which may be due to trauma.

Question 6

Generate a management plan for subdural haemorrhage.

Answer 6

All patients on anticoagulation should have their antiplatelet or anticoagulant agent stopped and/or reversed. All patients require serial prothrombin time, partial thromboplastin time, international normalised ratio, and platelet and fibrinogen levels followed.
In order to reduce ICP, consider raising the head or surgical intervention if it’s severe.