Subdural Heamorrhage Flashcards
Define the two types of Subdural Heamorrhage
Bleeding that causes blood to accumulate bewteen dura and arachnoid layer of the brain. often associated with head trauma, can present immediatly or months later
acute-often in younger people, as the accumulating blood doesnt have much space-pushes brain fast and causes symptoms-needs fast treatment for best results
Chornic-brain atrophy means the blood has more space to go before pushing around-clots —but still enlarges overtime-and will cause symptoms after a bit
Aetiology and risk factors of Subdural Heamorrhage
Bleed from the sinuses between dura and subarachnoid-usually from bridging veins bewteen cortex and venous sinuses–vulnerable to deceleration injury
Main cause is TRAUMA-but can be a small one up to 9 months ago-often forgotten
can happen without trauma-dural metastases, low ICP
acute-more young people
chronic-older-and more common form of SDH
Risk factors: Anticoagulations, trauma, elderly (atrophy makes more space, slower), falls (epileptic, alcoholic)
Signs and Sx of Subdural Heamorrhage
FLUCTUATING-when acute usually not at 15 ever- conciousness after a head injury (but can be a few months before so forgotten)
Intelectual slowing, tiredeness, sleepiness, headache, personality change and unsteadiness
UMN neuro signs will depend of what area is affected, but can be any (weakness, snesory, talking, hearing, eyesight, confusion etc)
WEAKNESS, SPASTIC etc
EYES-
can get nose bleed and ear bleed if basilar bone is broken–look out for battles sign
signs:
raised ICP, seizures,
localising UMN neuro symptoms (eg hemiparesis, unequal pupils, etc-depending on area) long time after injury
BANANA shaped CT
Investigations of Subdural Heamorrhage
CT/MRI-banana shaped bleed, -main difference from extradural
can show after a while-clot + midline shift of the brain
no LP
Management of Subdural Heamorrhage
Irrigation/evacuation, eg via burr twist drill and burr hole craniostomy, can be considered 1st-line; craniotomy is 2nd-line-if the clot has organized
not all SDH are severe enough to need drainage-if they do prognosis is worse
acute–if small and non expansile-observe, anti-epileptics and balance coagulation
if big-surgery (as above)
chronic-observe, anti-epileptics, ELECTIVE surgery in some, Cranial pressure relieving regimens
Complications of Subdural Heamorrhage
Raised ICP-
cause brainstem compression and respiratory arrest-bradycardia and raised HTN is some of the later signs of it-death -high death if not treated
also can cause stroke from midline shifting
Even if dealt but late-brain damage and permanent loss of function of the areas affected
Notalways recover-
