Subdural haemorrhage

Between arachnoid and dura mater
Acute, chronic, acute on chronic.

After trauma. Usually venous bleed


Elderly
Hypertension
Falls
Anticoagulant therapy



TRAUMA
INCREASED ICP
BRAIN METS


Elderly patients at risk due to shrinkage of brain with age as a result of atherosclerosis.
DAMAGE to bridging veins


Symptoms

Drowsiness
Consciousness
Personality change

Other signs

Increased ICP
Seizures

Late signs

ONSET OF INJURY TO TIME OF FOCAL SYMPTOMS IS 63 days!!!


Investigations
CT/MRI
Hypodense chronic bleed, Hyperdense acute bleed

Differential

Stroke
Dementia
Mass lesion

Treatment

Irrigation/evacuation/Burr hole craniostomy - via a burr twist drill. Basically a hole is drilled into the skull
Craniotomy - flap of bone cut and temproarily left open to relieve high ICP. Used less often than burr hole.
Try to find cause of trauma - e.g. cause of falls, cataracts