Subdural haematoma

Question 1

What is a subdural haematoma

Answer 1

Bleeding from bridging veins between cortex and venous sinuses (vulnerable to deceleration injury) resulting in accumulating haematoma between dura and arachnoid

Question 2

What happens due to a subdural haematoma

Answer 2

Increased ICP
Shifting of midline structures away from side of the clot
Tentorial herniation
Coning

Question 3

What causes subdural haematomas

Answer 3

Trauma (up to 9 months ago)
Decreased ICP
Dural metastases

Question 4

What are risk factors for subdural haematomas

Answer 4

Alcoholics
Elderly - atrophy of the brain
Anticoagulation
Falls - epileptics

Question 5

Describe the symptoms of a subdural haematoma

Answer 5

Fluctuating level of consciousness
Insidious physical or intellectual slowing
Sleepiness
Headache
Personality change 
Unsteadiness

Question 6

Describe the signs of a subdural haematoma

Answer 6

Increased ICP
Seizures
Localizing neurological symptoms occurring late after the injury >1month after

Question 7

What are the important differentials of a subdural haematoma

Answer 7

Stroke
Dementia
CNS masses

Question 8

What imaging is required to diagnose subdural haematoma

Answer 8

CT/MRI shows crescent shaped collection of blood over 1 hemisphere (sickle shape)
Midline shift may be present (be aware of bilateral isodense clots)

Question 9

Describe the management of subdural haematoma

Answer 9

Reverse clotting abnormalities urgently
Surgical management depends on the size of the clot, its chronicity and clinical picture
Those >10mm or with midline shift >5mm need evacuating via craniotomy or burr hole washout
Address the cause of the trauma (falls and abuse)