Subdural Haemorrhage Flashcards
Define subdural Haemorrhage?
A collection of blood that develops between the surface of the brain and the dura mater
What is the classification of Subdural Haemorrhage?
Acute: < 72 hrs
Subacute: 3-20 days
Chronic: > 3 weeks
What are the main causes of subdural haemorrhage
Trauma (usually due to rapid acceleration and deceleration of the brain)
What is the epidemiology of SDH?
Acute - Younger patients/associated with major trauma
More common than extradural haemorrhage
Chronic - more common in the ELDERLY
What are the Acute presenting symptoms of SDH?
History of Trauma with head injury
Reduced Conscious Level
What are the Subacute presenting symptoms of SDH?
Worsening Headache 7-14 days after injury
Altered mental state
What are the chronic presenting symptoms of SDH?
Headache Confusion Cognitive Impairment Psychiatric Symptoms Gait Deterioration Focal Weakness Seizures
What are the acute signs of SDH on physical examination?
Reduced GCS
Ipsilateral fixed dilated pupil (if a large haematoma cause a midline shift)
Pressure on brainstem leads to reduced consiousness + bradycardia
What are the chronic signs of SDH on physical examination?
Neurological examination may be normal
Focal neurological signs (e.g. 3rd nerve palsy_
What are the appropriate investigations for SDH?
CT head
MRI brain - higher sensitivity than CT
What is the acute management plan for SDH?
ALS protocol
Watch out for cervical spine injury
If raised ICP consider osmotic diuresis
In what situation would you be conservative with your management plan for SDH?
If the SDH is small
What is the surgical plan for SDH?
Prompt Burr hole or craniotomy
What is the chronic management plan for SDH?
If symptomatic - Burr hole or craniotomy and drainage
What is the manegement plan for SDH in chiildren?
Younger children may be treated with percutaneous aspiration via an open fontanelle
