Subdural Haemorrhage

Question 1

What is the definition of a subdural haemorrhage?

Answer 1

A collection of blood that develops between the surface of the brain and the dura mater

Question 2

How are subdural haemorrhages classified?

Answer 2

• Acute - less than 72 hrs
• Subacute - 3-20 days
• Chronic - 3+ weeks

Question 3

Explain the aetiology of subdural haemorrhage?

Answer 3

Trauma (usually due to rapid acceleration and deceleration of the brain)

Question 4

What is the epidemiology of subdural haemorrhages?

Answer 4

Acute - younger patients/associated with major trauma

MORE COMMON than extradural haemorrhage

Chronic - more common in the ELDERLY

Question 5

What are the presenting symptoms of acute subdural haemorrhages?

Answer 5

History of TRAUMA with head injury

Reduced conscious level

Question 6

What are the presenting symptoms of subacute subdural haemorrhages?

Answer 6

Worsening headache 7-14 days after injury

Altered mental state

Question 7

What are the presenting symptoms of chronic subdural haemorrhages?

Answer 7

Headache

Confusion

Cognitive impairment

Psychiatric symptoms

Gait deterioration

Focal weakness

Seizures

Question 8

What are the signs of acute subdural haemorrhgaes upon physical examination?

Answer 8

Reduced GCS

Ipsilateral fixed dilated pupil (if a large haematoma cause a midline shift)

Pressure on brainstem –> reduced consciousness + bradycardia

Question 9

What are the signs of chronic subdural haemorrhgaes upon physical examination?

Answer 9

Neurological examination may be NORMAL

Focal neurological signs (e.g. 3rd nerve palsy)

Question 10

What are the appropriate investigations for a subdural haemorrhage?

Answer 10

CT Head

MRI Brain - higher sensitivity than CT

Question 11

How are subdural haemorrhages managed?

Answer 11

Acute:

• Follow ALS protocol
• Watch out for cervical spine injury
• If raised ICP consider osmotic diuresis

Conservative management may be possible if only a small haemorrhage

Can be surgically treated through a prompt burr hole or craniotomy

Chronic can be treated surgically (look above) if symptomatic then drained

Younger children can be treated with percutaneous aspiration via an open fontanelle

Question 12

What are the potential complications of a subdural haemorrhage?

Answer 12

Raised ICP

Cerebral oedema

Herniation

Post-Op - seizures, recurrence, intracerebral haemorrhage, brain abscess, meningitis, tension pneumocephalus

Question 13

What is the prognosis of subdural haemorrhages?

Answer 13

Acute
- Underlying brain injury will affect function

Chronic

• Better outcome than subdural haemorrhages
• Lower incidence of underlying brain injury