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Subdural Haematoma

Title               

Ñ    Subdural Haematoma

Definition

Ñ    Accumulation of blood in the subdural space

Due to:

Ñ    Tearing of the bridging veins between the cortex and the venous sinuses

Pathogenesis

Risk Factors

Ñ    Elderly

Ñ    Epileptics

Ñ    Alcoholics

Ñ    Anticoagulants

(2Es, 2As)

Pathological Process

Ñ    Deceleration injury causes rupture of veins with accumulation of blood between the dura and arachnoid

Clinical Features

History

Age

Ñ    More common in elderly

CNS

Ñ    Fluctuating level of consciousness

Ñ    Sleepiness

Ñ    Intellectual slowing

Ñ    Personality change

Ñ    Seizures

Ñ    Headache

Ñ    Unsteadiness

Past Illnesses

Ñ    Trauma to head:

May be trivial

Ñ    Epilepsy

Drug History

Ñ    Anticoagulation

Personal History

Ñ    Alcohol abuse

Examination

CNS

Ñ    Decreased level of consciousness

Ñ    Pupillary abnormalities

Ñ    Weakness of limbs

Complications

Ñ    Stupor

Ñ    Coma

Ñ    Coning

Investigations

Fluids

Blood

Haematology

Ñ    INR:

If on anticoagulants

Imaging

CT Scan

Ñ    Crescent shaped haematoma

Ñ    Midline shift

MRI

Ñ    Crescent shaped haematoma

Ñ    Midline shift

Management

Control

Surgery

Ñ    Evacuate haematoma

Prevention

Drugs

Ñ    Careful monitoring of anticoagulation

Lifestyle Adjustments

Abuse

Ñ    Stop alcohol abuse

Staffing

Ñ    Physiotherapy, occupational therapy, nursing care:

Prevent falls

Prognosis

Ñ    Reasonable outcome in the majority

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