Subdural hemorrhage: Difference between revisions
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==Background== | ==Background== | ||
* | * Can present as acute (<14 days) and chronic (>14 days) | ||
* | * Both types are caused by sudden acceleration-deceleration of the brain with resultant shearing of the bridging veins. | ||
* | ** Blood pools between the dura mater and arachnoid | ||
* Patients with extreme atrophy are at increased risk (elderly, alcoholics) | |||
** Patients less than 2 years old are also at increased risk | |||
* SDH are often associated with other brain injuries | |||
==Diagnosis== | ==Diagnosis== | ||
* Patients with acute SDH generally will present unconscious after a severe trauma | |||
* Patients with chronic SDH generally present with altered mental status or vague complaints | |||
* High index of suspicion warranted in the aforementioned groups of patients at increased risk with any history of head trauma regardless of severity | |||
==Workup== | ==Workup== | ||
{{Head trauma workup}} | {{Head trauma workup}} | ||
* Head CT is the gold standard | |||
** Acute SDH will show as a hyperdense (white) collection with a crescent-shaped appearance | |||
** Chronic SDH will show as a hypodense (dark grey/black) collection in a crescent-shape | |||
** Contrasted studies are useful in distinguishing acute, subacute, and chronic | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 13: | Line 25: | ||
==Management== | ==Management== | ||
* Emergent neurosurgical evacuation | |||
** Operative intervention generally for patients with focal findings, >10mm hematoma, midline shift > 5mm, signs of increased intracranial pressure (ICP). | |||
* Management of ICP | |||
** Head of bed to 30 degrees | |||
** Short-term use of hyperventilation | |||
** Hyperosmolar agents | |||
* Reversal of anticoagulation | |||
* Trephination (Burr holes) | |||
==See Also== | ==See Also== | ||
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*[[Head Trauma]] | *[[Head Trauma]] | ||
== | ==Further Reading== | ||
* Imaging | |||
http://radiopaedia.org/articles/subdural-haemorrhage | |||
* Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006;58(3 Suppl):S16-24. | |||
* Judith E. Tintinalli, Gabor Kelen, J. Stephan Stapczynski. SAMJ. New York : McGraw-Hill, Medical Pub. Division, c2004.; 2008. | |||
[[Category:Trauma]] | [[Category:Trauma]] | ||
[[Category:Neuro]] | [[Category:Neuro]] | ||
Revision as of 13:37, 16 March 2015
Background
- Can present as acute (<14 days) and chronic (>14 days)
- Both types are caused by sudden acceleration-deceleration of the brain with resultant shearing of the bridging veins.
- Blood pools between the dura mater and arachnoid
- Patients with extreme atrophy are at increased risk (elderly, alcoholics)
- Patients less than 2 years old are also at increased risk
- SDH are often associated with other brain injuries
Diagnosis
- Patients with acute SDH generally will present unconscious after a severe trauma
- Patients with chronic SDH generally present with altered mental status or vague complaints
- High index of suspicion warranted in the aforementioned groups of patients at increased risk with any history of head trauma regardless of severity
Workup
Workup
- Consider head CT (rule out intracranial hemorrhage)
- Use validated decision rule to determine need
- Avoid CT in patients with minor head injury who are at low risk based on validated decision rules.[1]
- Consider cervical and/or facial CT
- Head CT is the gold standard
- Acute SDH will show as a hyperdense (white) collection with a crescent-shaped appearance
- Chronic SDH will show as a hypodense (dark grey/black) collection in a crescent-shape
- Contrasted studies are useful in distinguishing acute, subacute, and chronic
Differential Diagnosis
Intracranial Hemorrhage Types
- Intra-axial
- Hemorrhagic stroke (Spontaneous intracerebral hemorrhage)
- Traumatic intracerebral hemorrhage
- Extra-axial
- Epidural hemorrhage
- Subdural hemorrhage
- Subarachnoid hemorrhage (aneurysmal intracranial hemorrhage)
Management
- Emergent neurosurgical evacuation
- Operative intervention generally for patients with focal findings, >10mm hematoma, midline shift > 5mm, signs of increased intracranial pressure (ICP).
- Management of ICP
- Head of bed to 30 degrees
- Short-term use of hyperventilation
- Hyperosmolar agents
- Reversal of anticoagulation
- Trephination (Burr holes)
See Also
Further Reading
- Imaging
http://radiopaedia.org/articles/subdural-haemorrhage
- Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006;58(3 Suppl):S16-24.
- Judith E. Tintinalli, Gabor Kelen, J. Stephan Stapczynski. SAMJ. New York : McGraw-Hill, Medical Pub. Division, c2004.; 2008.