Subdural Haemorrhage

Question 1

Define

Answer 1

DEFINITION: a collection of blood that develops between the surface of the brain and the dura mater

Classification

ACUTE: < 72 hrs

SUBACUTE: 3- 20 days

CHRONIC: > 3 weeks

Question 2

Causes

Answer 2

Trauma (usually due to rapid acceleration and deceleration of the brain)

Question 3

Epidemiology

Answer 3

Acute - younger patients/associated with major trauma

MORE COMMON than extradural haemorrhage

Chronic - more common in the ELDERLY

Question 4

Symptoms

Answer 4

Acute

• History of TRAUMA with head injury
• Reduced conscious level

Subacute

• Worsening headache 7-14 days after injury
• Altered mental state

Chronic

• Headache
• Confusion
• Cognitive impairment
• Psychiatric symptoms
• Gait deterioration
• Focal weakness
• Seizures

Question 5

Signs

Answer 5

Acute

• Reduced GCS
• Ipsilateral fixed dilated pupil (if a large haematoma cause a midline shift)
• Pressure on brainstem –> reduced consciousness + bradycardia

Chronic

Neurological examination may be NORMAL

Focal neurological signs (e.g. 3rd nerve palsy)

Question 6

Investigations

Answer 6

CT Head

MRI Brain - higher sensitivity than CT

Question 7

Management

Answer 7

ACUTE

• ALS protocol
• Watch out for cervical spine injury
• If raised ICP consider osmotic diuresis

Conservative - if small

Surgical

• Prompt Burr hole or craniotomy

Chronic

• If symptomatic - Burr hole or craniotomy and drainage

Children

• Younger children may be treated with percutaneous aspiration via an open fontanelle

Question 8

Complications

Answer 8

Raised ICP

Cerebral oedema

Herniation

Post-Op - seizures, recurrence, intracerebral haemorrhage, brain abscess, meningitis, tension pneumocephalus

Question 9

Prognosis

Answer 9

Acute

• Underlying brain injury will affect function

Chronic

• Better outcome than subdural haemorrhages
• Lower incidence of underlying brain injury