Subdural Hematoma

Question 1

CT brain, what does it show?

Answer 1

Lens / crescent shape hyperdense lesion. Right subdural hemorrhage

Question 2

What does loss of grey-white matter suggest?

Answer 2

Many studies have shown that injury to gray matter, areas of the brain that contains nerve cell bodies, can cause long-lasting cognitive disability.

Question 3

What is “GCS”, and what is her GCS?

Answer 3

Glasgow Coma Scale is a neurological scale which aims to give a reliable and objective way of recording the conscious state of a person for initial as well as subsequent assessment. Her GCS: 2+2+4=8

Question 4

Management of Acute SDH?

Answer 4

Urgent surgical evacuation of hematoma for

• Acute SDH, +/- coma, with neurologic deterioration (signs of increased intracranial pressure) since time of injury with potential for recovery

• Clot thickness 10mm or midline shift > 5mm on initial brain CT regardless of GCS

Nonsurgical managed patients should be nursed in ICU with ICP monitoring and serial head CT scans. Next scan at 6-8h. If there are signs of neurologic deterioration or persistently increased ICP (> 20mmHg), urgent surgical evacuation within 2-4h of deterioration

Question 5

Tracheostomy tube advantage?

Answer 5

• Easier cleaning of the mouth and face

• Less likely to aspirate

• Less dead space

• Better tolerated on the long term (more comfort, no gagging, doesn’t need sedation)

• May help weaning from the ventilator

• May allow swallowing and the ability to eat and drink