Subdural hemorrhage: Difference between revisions
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==Workup== | ==Workup== | ||
[[File:Subduralandherniation.png|thumb|Large left-sided frontal-parietal subdural hematoma with associated midline shift.]] | |||
{{Head trauma workup}} | {{Head trauma workup}} | ||
* Head CT is the gold standard | * Head CT is the gold standard | ||
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** Chronic SDH will show as a hypodense (dark grey/black) collection in a crescent-shape | ** 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 | ** Contrasted studies are useful in distinguishing acute, subacute, and chronic | ||
==Differential Diagnosis== | ==Differential Diagnosis== |
Revision as of 22:17, 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