SYB 2 Marni Scheiner MS IV Marni Scheiner MS IV

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Subdural Hematoma Typically following head trauma (falls/assaults) May follow minor trauma Acceleration/Deceleration Injury Rupture of bridging veins Accumulation of blood between the dura and arachnoid membranes Common in elderly, babies (shaken baby syndrome) and alcoholics.

Subdural Hematoma Signs and symptoms As quick as 24 hrs, but may appear as much as 2 weeks later. Vein hemorrhage= lower pressure than arteries (in epidural hematomas)=bleed more slowly H/x of recent head injury/fall LOC/ change in mental status/delerium/dementia Seizure Headache N/V Personality changes Slurred speech, inability to speak Ataxia Blurred vision If large enough, may cause signs of increased ICP or damage to part of the brain will be present. Signs and symptoms As quick as 24 hrs, but may appear as much as 2 weeks later. Vein hemorrhage= lower pressure than arteries (in epidural hematomas)=bleed more slowly H/x of recent head injury/fall LOC/ change in mental status/delerium/dementia Seizure Headache N/V Personality changes Slurred speech, inability to speak Ataxia Blurred vision If large enough, may cause signs of increased ICP or damage to part of the brain will be present.

Subdural Hematoma 3 subtypes: (depend on speed of onset) Acute due to trauma Most severe if associated with cerebral contusion most lethal of all head injuries -- high mortality rate (20%-50%)if they are not rapidly treated with surgical decompression. Subacute 3-7 days after acute injury Chronic 2-3 weeks after acute injury often after minor head trauma (50% pts have no identifiable cause) Slow bleed, repeated minor bleeds, and usually self limited Small subdural hematomas (<1cm wide) have much better outcomes than acute subdural bleeds 3 subtypes: (depend on speed of onset) Acute due to trauma Most severe if associated with cerebral contusion most lethal of all head injuries -- high mortality rate (20%-50%)if they are not rapidly treated with surgical decompression. Subacute 3-7 days after acute injury Chronic 2-3 weeks after acute injury often after minor head trauma (50% pts have no identifiable cause) Slow bleed, repeated minor bleeds, and usually self limited Small subdural hematomas (<1cm wide) have much better outcomes than acute subdural bleeds

Radiographic Signs of Subdural Hematoma MRI vs CT: MRI better for size and effect on brain. Non-contrast CT is primary means of making a diagnosis and eval for treatment. Non-contrast Head CT: General: Crosses the suture lines, but not the dural reflections (DOES NOT CROSS THE MIDLINE) Moderate/large size: cause midline shift. Look for edema, may indicate future herniation Usually no skull fracture MRI vs CT: MRI better for size and effect on brain. Non-contrast CT is primary means of making a diagnosis and eval for treatment. Non-contrast Head CT: General: Crosses the suture lines, but not the dural reflections (DOES NOT CROSS THE MIDLINE) Moderate/large size: cause midline shift. Look for edema, may indicate future herniation Usually no skull fracture

Radiographic- Subdural Noncontrast Head CT: Acute: hyperdense, crescentic shaped Most common area: parietal region, and above the tentorium cerebelli Sub-acute: Isodense (with respect to brain) More difficult to see with non-contrast. Contrast-enhanced CT or MRI recommended for imaging hrs after injury. Chronic: Hypodense, easy to see on non-contrast head CT scan. Noncontrast Head CT: Acute: hyperdense, crescentic shaped Most common area: parietal region, and above the tentorium cerebelli Sub-acute: Isodense (with respect to brain) More difficult to see with non-contrast. Contrast-enhanced CT or MRI recommended for imaging hrs after injury. Chronic: Hypodense, easy to see on non-contrast head CT scan.

Pathophysiology Collected bood--> draw in water osmotically-->brain expansion--> compression of brain tissue--> new bleeds/tearing other blood vessels. Sometimes, arachnoid layer is torn--> CSF and blood both expand in the intracranial space--> increasing ICP. If self-limited: The body gradually reabsorbs the clot and replaces it with granulation tissue. Collected bood--> draw in water osmotically-->brain expansion--> compression of brain tissue--> new bleeds/tearing other blood vessels. Sometimes, arachnoid layer is torn--> CSF and blood both expand in the intracranial space--> increasing ICP. If self-limited: The body gradually reabsorbs the clot and replaces it with granulation tissue.

Treatment Depends on hematoma size and rate of growth. Small subdural hematomas: careful monitoring until the body heals itself Large or symptomatic hematomas: Craniotomy (open skull, remove blood clot, and control site of bleeding) Post-op complications: increased ICP, brain edema, bleeding, infection, and seizure. Depends on hematoma size and rate of growth. Small subdural hematomas: careful monitoring until the body heals itself Large or symptomatic hematomas: Craniotomy (open skull, remove blood clot, and control site of bleeding) Post-op complications: increased ICP, brain edema, bleeding, infection, and seizure.