Subdural Haemorrhage

Question 1

What is a subdural haemorrhage?

Answer 1

a collection of blood that develops between the dura mater + arachnoid mater

Question 2

What is the aetiology of subdural haemorrhage?

Answer 2

Trauma causing rapid acceleration + deceleration of the brain results in shearing forces which tear “bridging veins” between dura + cortex

Question 3

What is the epidemiology of subdural haemorrhage?

Answer 3

Acute: younger patients/ associated with major trauma
MORE COMMON than extradural haemorrhage
Chronic: more common in the ELDERLY

Question 4

List 2 symptoms of acute subdural haemorrhage

Answer 4

Hx of TRAUMA with head injury

Reduced conscious level

Question 5

List 3 signs of acute subdural haemorrhage

Answer 5

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

Question 6

What are the investigations for subdural haemorrhage?

Answer 6

CT Head

MRI Brain - higher sensitivity than CT

Question 7

What is the management plan for acute subdural haemorrhage?

Answer 7

ALS protocol 
Detect cervical spine injury 
If raised ICP, raise head + consider osmotic diuresis  
Conservative`; if small  
Surgical: Prompt Burr hole or craniotomy

Question 8

What are the treatment options for chronic subdural haemorrhage?

Answer 8

If symptomatic: Burr hole or craniotomy and drainage

If asymptomatic: conservative, serial imaging

Question 9

What are 3 complications of subdural haemorrhage?

Answer 9

Raised ICP
Cerebral oedema
Herniation

Question 10

What is the prognosis for acute subdural haemorrhage?

Answer 10

Underlying brain injury will affect function

Question 11

What is the prognosis for chronic subdural haemorrhage?

Answer 11

Better outcome than acute subdural haemorrhages

Lower incidence of underlying brain injury

Question 12

List 7 symptoms of chronic subdural haemorrhage

Answer 12

Headache 
Confusion 
Cognitive impairment  
Psychiatric symptoms  
Gait deterioration  
Focal weakness  
Seizures

Question 13

List signs of chronic subdural haemorrhage

Answer 13

Neurological examination may be NORMAL

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

Question 14

Describe the classification of subdural haemorrhages

Answer 14

ACUTE: < 72 hrs
SUBACUTE: 3- 20 days
CHRONIC: > 3 weeks

Question 15

Give 2 symptoms of subacute subdural haemorrhage

Answer 15

Worsening headache 7-14 days after injury

Altered mental state

Question 16

What treatment my be used in children with subdural haemorrhage?

Answer 16

Percutaneous aspiration via an open fontanelle

Question 17

Why should you have a low index of suspicion in the elderly + alcoholics?

Answer 17

There may not be a hx of fall/ trauma

Question 18

Describe the appearance of subdural haemorrhage on CT

Answer 18

Crescent/ sickle shaped mass
Concave over brain surface
“Banana shaped”

Question 19

List 7 post-op complications of subdural haemorrhage

Answer 19

Seizures
Recurrence
Intracerebral haemorrhage
Subdural empyema 
Brain abscess
Meningitis
Tension pneumocephalus