Subdural Haemorrhage

Question 1

Where does blood collect in a subdural haemorrhage?

Answer 1

Between the meningeal dura mater and arachnoid mater

Question 2

What age group is mostly affected by subdural haemorrhages?

Answer 2

All age groups

Could be acute <3 days, subacute 3-21 days or chronic > 3 weeks

Question 3

What veins usually cause the bleeding?

Answer 3

Shearing forces on cortical bridging veins.

Question 4

What mechanism usually causes a SDH?

Answer 4

Usually traumatic but may be spontaneous

Question 5

What can increase the risk of bridging vein rupture?

Answer 5

Cerebral atrophy

Question 6

Bridging veins connect what part of the brain together?

Answer 6

Cerebral veins in the subarachnoid space and venous sinuses (space between periosteal and meningeal layers)

Question 7

Acute SDH usually present in the setting of…

Answer 7

Head trauma

Neurological abnormalities in up to 80%

Question 8

Subacute/ chronic SDH are more common in what age group?

Answer 8

Elderly - with vague or absent history of trauma.

May present with insidious onset of confusion and general cognitive decline

Question 9

How do acute bleeds present on CT?

Answer 9

Hyperdense - bright white

Question 10

On a CT an acute bleed appears bright white, but over time it will become…

Answer 10

Progressively hypodense (darker than brain tissue)

Question 11

On a CT scan, what shape is a SDH?

Answer 11

Crescent/ sickle shape

Question 12

How should acute collections be managed?

Answer 12

Neurosurgical intervention to relieved raised ICP

Question 13

Symptomatic subacute/ chronic SDH are often treated with what?

Answer 13

Burr holes - surgical decompression

Question 14

Is prognosis better or worse than EDH?

Answer 14

Relatively poor

Question 15

Worse outcomes occur in patients who are..

Answer 15

Anticoagulated

Question 16

Is the bleed bound by suture lines?

Answer 16

No

Question 17

Large acute subdural haematomas will push on the brain and cause what?

Answer 17

Midline shift or herniation

Question 18

If the chronic subdural is an incidental finding or if small with no neurological deficit , what can be done?

Answer 18

It can be managed conservatively - will dissolve over time

Question 19

What symptoms are seen?

Answer 19

Fluctuating level of consciousness 
Physical or intellectual slowing
Headache
Personality change 
Unsteadiness

Question 20

What are some associated signs?

Answer 20

Raised ICP
Seizures
Localising neurological signs e.g unequal pupils, hemiparesis