Subdural haemorrhage

Question 1

Acute

Answer 1

Most commonly caused by high impact trauma

Presentation ranges from incidental finding to severe coma and coning due to herniation

CT: crescentic collection not limited by suture lines; hyperdense (bright); may cause midline shift

Question 2

Acute management

Answer 2

Small/ incidental observed conservatively

Surgical options include monitoring of intracranial pressure and decompressive craniectomy

Question 3

Chronic subdural haematoma

Answer 3

Collection of blood present for weeks to months

Ruptured small bridging veins cause slow bleeding

Presentation: weeks/months confusions, reduced consciousness or neurological defecit

CT: crescentic shape; not limited by suture lines; dark compared to the brain

Question 4

Risk factors for chronic subdural

Answer 4

Elderly and alcoholic patients as they have brain atrophy and fragile/ taut bridging veins

Question 5

Chronic management

Answer 5

Incidental/ small with no neurological deficit: conservative management

Confused/ neurological deficit: surgical decompression with burr holes