Subdural Haemorrhage

Question 1

define a subdural haemorrhage?

Answer 1

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

Question 2

what vessels are damaged in a subdural haemorrhage?

Answer 2

bridging veins between the cortex and the venous sinuses

Question 3

what are the classifications of a subdural haemorrhage?

Answer 3

o ACUTE: < 72 hrs
o SUBACUTE: 3- 20 days
o CHRONIC: > 3 weeks

Question 4

what are the causes of acute and chronic subdurals?

Answer 4

• ACUTE: Trauma (high impact trauma )
• CHORNIC: being elderly or alcoholic (rupture of the small bridging veins within the subdural space and cause slow bleeding due to brain atrophy)

Question 5

epidemiology of acute and chronic subdurals?

Answer 5

• Acute - younger patients/associated with major trauma
• MORE COMMON than extradural haemorrhage
• Chronic - more common in the ELDERLY

Question 6

what are the presenting symptoms of a subdural haemorrhage?

Answer 6

•	Acute 
o	History of TRAUMA with head injury  
o	Reduced conscious level  
•	Chronic 
o	Headache 
o	Confusion 
o	Cognitive impairment  
o	Psychiatric symptoms  
o	Gait deterioration  
o	Focal weakness  
o	Seizures

Question 7

what are the signs of an acute and chronic subdural?

Answer 7

• Acute
o Reduced GCS
o Ipsilateral fixed dilated pupil (if a large haematoma cause a midline shift)
o Pressure on brainstem –> reduced consciousness + bradycardia
• Chronic
o Neurological examination may be NORMAL
o Focal neurological signs (e.g. 3rd nerve palsy)

Question 8

what is the first line investigation for a subdural?

Answer 8

CT head

Question 9

what might a CT head show for an acute and chronic subdural?

Answer 9

• CT Head – crescent shape
• Acute: hyperdense (very bright)
• Chronic: hypodense (very dark)

Question 10

management plan for an acute subdural?

Answer 10

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

Question 11

surgical approach for subdural?

Answer 11

o Prompt Burr hole or craniotomy

Question 12

how might a small subdural be managed?

Answer 12

conservatively

Question 13

complications of a subdural?

Answer 13

• Raised ICP
• Cerebral oedema
• Herniation
• Post-Op

Question 14

prognosis for acute vs chronic subdural?

Answer 14

• Acute
o Underlying brain injury will affect function
• Chronic
o Better outcome
o Lower incidence of underlying brain injury