Subdural Haematoma Flashcards
What is SDH?
Collection of blood between dura and arachnoid layer
Typical cause of SDH?
Traumatic event
Acute: High impact head trauma- rupture of bridging veins
Chronic: Assoc with brain atrophy
What are the bridging veins?
Veins in SA space which puncture dura matter to drain into dural venous sinuses hence they bleed under the dura
Brain atrophy occurs due to…?
Age
Chronic alcoholism
Dementia
What happens to bridging veins in chronic SDH?
Stretched: meaning even minor trauma can cause them to rupture, leaky vessels cause blood to accumulate in the space
Presentation of acute SDH?
- Patient becomes almost immediately symptomatic following head trauma
- Severely decreased state of consciousness
Chronic presentation of SDH?
- More insidious course
- Headache and confusion
- Urinary incontinence
- Weakness
- Seizures
- Cognitive dysfunction
- Gait abnormalities
Imaging of choice for SDH?
Unenhanced CT
How does SDH appear on CT?
Semilunar shape because blood is not bounded by the fissures like it is in extradural haemorrhage
Differences between acute and chronic SDH on imaging?
Acute: Crescent shape hyperdensity
Chronic: Hypodense crescent shaped appearance
Management of SDH?
- May not need immediate treatment
- Even larger collections can resolve independently
- Serial imaging required
-Can be drained surgically if needed
