Subdural hemorrhage: Difference between revisions
(Formatting, updated info) |
Neil.m.young (talk | contribs) (standard format, dispo added, ref'd, and link) |
||
| Line 26: | Line 26: | ||
==Management== | ==Management== | ||
* Emergent neurosurgical evacuation | * Emergent neurosurgical evacuation | ||
** Operative intervention generally for patients with focal findings, >10mm hematoma, midline shift > 5mm, signs of increased intracranial pressure (ICP). | ** Operative intervention generally for patients with focal findings, >10mm hematoma, midline shift > 5mm, signs of increased intracranial pressure (ICP)<ref>Bullock MR, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006; 58(3):S16-24</ref> | ||
* Management of ICP | * Management of ICP | ||
** Head of bed to 30 degrees | ** Head of bed to 30 degrees | ||
** Short-term use of hyperventilation | ** Short-term use of hyperventilation | ||
** Hyperosmolar agents | ** Hyperosmolar agents ([[Mannitol, 3% saline) | ||
* Reversal of anticoagulation | * [[Coagulopathy (Main)|Reversal of anticoagulation]] | ||
* Trephination (Burr holes) | * Trephination (Burr holes) | ||
==Disposition== | |||
*Admission to NS or trauma surgery | |||
*Considered high level of care for q1-2hr neuro checks | |||
==See Also== | ==See Also== | ||
| Line 38: | Line 42: | ||
*[[Head Trauma]] | *[[Head Trauma]] | ||
== | ==External Links== | ||
* | *[http://radiopaedia.org/articles/subdural-haemorrhage SDH Radiographs] | ||
http://radiopaedia.org/articles/subdural-haemorrhage | |||
==References== | |||
<references/> | |||
[[Category:Trauma]] | [[Category:Trauma]] | ||
[[Category:Neuro]] | [[Category:Neuro]] | ||
Revision as of 18:10, 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)[2]
- Management of ICP
- Head of bed to 30 degrees
- Short-term use of hyperventilation
- Hyperosmolar agents ([[Mannitol, 3% saline)
- Reversal of anticoagulation
- Trephination (Burr holes)
Disposition
- Admission to NS or trauma surgery
- Considered high level of care for q1-2hr neuro checks
See Also
External Links
References
- ↑ Choosing wisely ACEP
- ↑ Bullock MR, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006; 58(3):S16-24