Condition- Subdural Haemorrhage Flashcards
What is a Subdural Haemorrhage?
A collection of blood that develops between the dura and the arachnoid mater
Describe the classification subdural haemorrhages based on onset.
- ACUTE: <72hrs
- SUBACUTE: 3-20 days
- CHONIC: >3weeks
What is the main cause of SDH?
TRAUMA usually rapid acceleration and deceleration- trauma may have been 9 months ago
List some risk factors and people who are at greater risk of SDH?
- Falls (alcoholics, elderly, epileptics)
- Age- brain atrophy which makes bridging veins between cotex and venous sinuses vulnerable
- Anti-coagulation
- Low ICP
- Dural metastses
Which type of haemorrhage is the most common?
SDH
Which age group is acute and chronic SDH more common in?
Acute- younger patients (major trauma)
Chronic- Elderly (due to brain atrophy and increased fall risk)
Describe the presentation of a patient with acute, subacute and chronic SDH?
ACUTE
- Trauma
- Reduced Consciousness
SUBACUTE
- Worsening headache
- Altered Mental State
CHRONIC
- headache
- confusion
- cognitive imairment
- gait deterioration
- focal weakness
- seizures
- sleepiness
Describe some of the signs of SDH on physical examination
- Reduced GCS
- Ipsilateral fixed dilated pupil (if midline shift)
- Pressure on brainstem –> reduced consciousness + bradycardia + hypertension (CUSHINGS)
- Normal neurological examination
- Focal neurological signs (3rd nerve palsy, sensory changes, cogitive changes,
List some appropriate investigations for a patient with SDH…
- CT Head or MRI Brain
- Can see midline shift
- Can also see crescent shaped collection of blood over one hemisphere-the sickle shape differentiates subdural blood from extradural haemorrhage (lens shaped)
Which type of haemorrhage is this? Which groups of the population are at a greater risk of this?
Subdural Haemorrhage
Elderly (falls) and Alcoholics
How would you acutely manage an SDH which is less than 10mm with a non-expansile midline shift <5mm and with no significant neuro deficits?
- Observation, monitoring and imaging
- Prophylactic anti-epileptics
- Correction of coagulopathy
- ICP lowering regimen (raising head of bed, analgaesics, hyperosmolar therapy)
How would you acutely manage an SDH which is greater than 10mm with a midline shift >5mm and with significant neuro deficits?
- A-E assessment and urgent neurosurgery referral
- Surgery:
- 1st line: Burr Hole craniotomy and drainage
- 2nd line: Trauma craniotomy (removal of temporfrontal lobe)
How would you manage an elderly patient presenting with a chronic SDH?
- A-E assessment
- Prophylactic antieileptics- phenytoin
- Elective surgery
- Twis and drill burr
- Burr Hole craniotomy + drainage
- Obs and Monitoring
- Correction of coagulopathy
- ICP lowering regimen
What are the different surgical interventions to manage SDH?
- burr hole craniotomy: At least 2 burr holes are made and the clot is irrigated using saline irrigation and suction
- Trauma craniotomy: Frontotemporoparietal craniotomy, durotomy, and removal of the clot
- Hemicraniectomy: Frontotemporoparietal craniotomy, durotomy, and removal of the clot without replacement of the bone flap
List some of the possible complications of SDH…
- Rasied ICP
- Herniaton
- Cerebral oedema
- Stroke
- Coma
- Post-op: Infection, Epilepsy, recurrence
