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A2025 general knowledge > subdural hematoma > Flashcards

subdural hematoma Flashcards

1
Q

What does subdural hematoma (SDH) refer to?

A

Bleeding into the intracranial subdural space caused by rupture of bridging veins

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2
Q

What are common etiologies of SDH?

A
  • Trauma
  • Minor falls
  • Cerebral atrophy
  • Conditions increasing risk of bleeding (e.g., coagulopathy, hypertension)
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3
Q

How can SDH be classified based on the onset of symptoms?

A
  • Acute SDH
  • Subacute SDH
  • Chronic SDH
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4
Q

What are typical symptoms of acutely symptomatic SDH?

A
  • Altered mental status
  • Focal neurological signs
  • Signs of increased ICP
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5
Q

What can acutely symptomatic SDH progress to if not treated?

A

Brain herniation and death

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6
Q

What are common manifestations of chronic SDH?

A
  • Cognitive deficits
  • Impaired memory
  • Personality changes
  • Focal neurological signs
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7
Q

What can subacute SDH manifest with?

A

Features of acute and/or chronic SDH

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8
Q

What takes precedence in patients with acutely symptomatic SDH?

A

Neuroprotective measures to prevent secondary brain injury

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9
Q

How is the diagnosis of SDH confirmed?

A

With a noncontrast head CT

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10
Q

What does a noncontrast head CT show in cases of SDH?

A

A crescent-shaped (concave) lesion that may cross cranial sutures, typically in the supratentorial region

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11
Q

When is surgery recommended for SDH?

A
  • If symptomatic
  • If ≥ 10 mm in size
  • If causing ≥ 5 mm shift in the midline
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12
Q

What management can be considered for small asymptomatic SDHs?

A

Conservative management in patients with no signs of increased ICP

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13
Q

What is the primary cause of acute SDH?

A

Blunt head trauma due to high-energy impact, such as motor vehicle accidents.

Other causes include nonaccidental trauma and acceleration-deceleration injury.

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14
Q

What is a common cause of chronic SDH in adults?

A

Mild trauma secondary to falls due to factors like old age, alcohol use disorder, epilepsy, and hyponatremia.

Chronic SDH can also occur due to nontraumatic factors.

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15
Q

What nonaccidental trauma is associated with chronic SDH in infants?

A

Shaken baby syndrome.

Birth trauma is also a contributing factor.

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16
Q

List three neurodegenerative diseases associated with chronic SDH in adults.

A
  • Alzheimer disease
  • Dementia (including HIV dementia, vascular dementia)
  • Chronic diabetes mellitus
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17
Q

What increased risk factors can lead to hemorrhage in SDH patients?

A
  • Antithrombotic therapy or coagulopathy
  • Intracranial aneurysm
  • Intracranial arteriovenous malformation
  • Intracranial tumors
  • Hypertension
  • Arteriosclerosis
  • Hemodialysis
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18
Q

What is an iatrogenic cause of SDH?

A

After neurosurgical procedures.

Iatrogenic causes are those resulting from medical intervention.

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19
Q

What condition can lead to nontraumatic chronic SDH in infants and young children?

A

Meningitis.

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20
Q

Fill in the blank: Chronic SDH in adults can be caused by _______.

A

[cerebral atrophy].

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21
Q

What is the typical symptom onset for acute subdural hematoma (SDH)?

A

Immediately after (or within 3 days of) the inciting event

22
Q

What percentage of patients experience a lucid interval between head injury and onset of neurological symptoms in acute SDH?

23
Q

What can acute SDH progress to?

A

Cerebral herniation and death

24
Q

Name common clinical feature of acute SDH.

A

Impaired consciousness and confusion
focal neurological signs
pupillary abnormaities
symptoms of raised ICP
cerebral herniation syndromes
abnormal posturing
seizures

25
What are focal neurological signs associated with acute SDH?
* Contralateral hemiparesis and UMN signs * Ipsilateral hemiparesis due to Kernohan syndrome * Cranial nerve palsies manifesting as diplopia, blurred vision, unequal pupils, anosmia * slurred speech
26
List some manifestations of increased intracranial pressure (ICP).
* Headache * Vomiting * Cushing triad
27
what is cushings triad
A hypothalamic response to maintain cerebral perfusion in patients with elevated ICP. Results in the Cushing triad, which consists of increased systolic blood pressure, bradycardia, and irregular breathing
28
What is the symptom onset time frame for subacute SDH?
4–20 days after the inciting event
29
What clinical features are associated with chronic SDH?
* Altered mental state: confusion, Delirium, Excessive drowsiness * Recurrent headaches * Cognitive deficits: Impaired memory, Dementia * focal neurological signs * ataxia and falls * personality changes
30
What differentiates acute SDH and acute epidural hematoma (EDH) clinically?
They have similar clinical manifestations and are indistinguishable without neuroimaging
31
Fill in the blank: Acute SDH symptom onset is typically _______.
immediately after (or within 3 days of) the inciting event
32
What is the first-line imaging modality for suspected acute SDH?
CT head without IV contrast
33
What are the characteristic findings of acute subdural hematoma (SDH)?
Crescent-shaped, concave, sharply demarcated extraaxial lesion
34
Can acute SDH cross cranial suture lines?
Yes ## Footnote This characteristic helps differentiate it from other types of hematomas.
35
Does acute SDH cross the midline?
No ## Footnote This is a distinguishing feature of acute SDH.
36
What can a large unilateral SDH cause?
Midline shift to the contralateral side ## Footnote Midline shift may be less significant or absent in bilateral SDH.
37
What is the radiodensity of acute SDH?
Hyperdense ## Footnote This indicates fresh hemorrhage.
38
What is the radiodensity of subacute SDH?
Isodense ## Footnote This reflects a more advanced stage of the hematoma. MRI head is the preferred imaging when subacute SDH is suspected
39
What is the radiodensity of chronic SDH?
Hypodense ## Footnote This indicates older hematoma.
40
what are the characteristic MRI findings of SDH
Acute SDH: hypointense Subacute SDH: hyperintense Chronic SDH: hyperintense core with a hypointense rim
41
What should chronic SDH be differentiated from?
Subdural hygroma ## Footnote Subdural hygroma is a collection of CSF in the subdural space, often caused by a tear in the arachnoid membrane following head injury.
42
What is a characteristic of subdural hygroma?
Difficult to distinguish from a chronic SDH on CT scan ## Footnote This difficulty can complicate diagnosis and treatment planning.
43
What is recommended for symptomatic subdural hygroma?
Surgical evacuation ## Footnote This intervention may alleviate symptoms and prevent further complications.
44
What does medical management of symptomatic SDH include?
Neuroprotective measures, empiric ICP management if signs of ↑ ICP ## Footnote These actions are crucial to prevent further neurological damage.
45
What pupil condition indicates a potential emergency?
Unilateral or bilateral fixed dilated pupils ## Footnote This condition is often associated with severe brain injury
46
What ICP level necessitates urgent intervention?
ICP > 20 mm Hg ## Footnote Elevated intracranial pressure can lead to brain herniation and requires immediate action
47
What is a potential emergency procedure for cerebral herniation syndromes?
Emergency craniotomy or decompressive craniectomy ## Footnote These procedures relieve pressure on the brain
48
What should be considered if definitive neurosurgical management is delayed?
Emergency temporizing burr hole craniotomy ## Footnote This is a temporary measure to alleviate pressure while awaiting further treatment
49
What surgical intervention is indicated for acute subdural hematoma?
Craniotomy with evacuation of hematoma ## Footnote This procedure aims to remove the hematoma and relieve pressure
50
What is a possible intervention for subacute and chronic subdural hematomas?
Definitive surgery: Craniotomy and clot evacuation (with/without drain placement) ## Footnote This is necessary to manage ongoing bleeding or fluid accumulation
51
What should be considered for elderly or high surgical risk patients?
Minimally invasive or bedside interventions, e.g., twist drill craniostomy ## Footnote These techniques reduce the risk associated with more invasive surgeries
52
does EDH or SDH have worse prognosis
Acute SDH has a higher likelihood of an underlying parenchymal injury and is therefore associated with a worse prognosis than acute EDH

A2025 general knowledge (8 decks)

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