subdural haemorrhage Flashcards
what is the typical presentation of SDH?
Elderly and falls, gradual worsening headache around a week after injury, fluctuating consciousness, confusion, personality changes - May have raised ICP signs
Define SDH?
A collection of blood that develops between the dural and arachnoid mater
Outline the classification of SDH?
ACUTE: < 72 hrs (diffusely hyperdense)
SUBACUTE: 3 - 21 days (heterogenous: hyperdense/isodense)
CHRONIC: > 3 weeks (diffusely hyoodense)
outline the aetiology of a SDH?
Rupture of the bridging veins (susceptible in elderlyand alcoholics, due to brain atrophy)
What are the risk factors of a SDH?
Falls (epileptics, alcoholics)
Low ICP
Dural metastases
Age – brain atrophy makes bridging veins between cortex and venous sinuses vulnerable
Anticoagulation
Outline the epidemiology of a SDH
Acute - younger patients/associated with major trauma
MORE COMMON than extradural haemorrhage
Chronic - more common in the ELDERLY
What are the appopriate investigations for a SDH?
Urgent Non contrast CT-head (Banana shape)
what are the possible complications of a SDH?
Raised ICP
Cerebral oedema
Herniation
Post-Op - seizures, recurrence, intracerebral haemorrhage, brain abscess, meningitis, tension pneumocephalus
Outline the prognosis of SDH?
Acute- Underlying brain injury will affect function
Chronic
- Better outcome than acute subdural haemorrhages
- Lower incidence of underlying brain injury
outline the onset and timing of subdural haemorrhage
gradual and continuous
what are the associated symptoms of SDH?
- Fluctuating consciousness
- Confusion
- Personality changes
- Symptoms of ↑ ICP
Outline the management for SDH?
Immediate: ALS protocol, C-spine protection, inc.ICP-> mannitol
Acute:
- Small <10mm, midline shift <5mm, no sig. neuro sx=> Conservative + Prophylactic antiepileptics
- Large: >10mm, >5mm midline shift, sig. neuro sx=> Irrigation and evacuation: 1. Burr holes, 2. Craniotomy
Chronic – Burr Holes
Summarises the differences between the brain haemorrhages?
