Subdural hemorrhage (acute + chronic)

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FACTS

 

HPI

universal ROS
+ etoh use, AC use, functional status, GOC
+ hx coagulopathy, bleeding diathesis in self/family?
PHYSICAL EXAM
universal exam
+ GCS

IMAGING

 
MRI Brain w/o contrast w/ T1 axial sequence to evaluate T1 character (T1 hypo-intense generally more amenable to MMA
A/P
  • Blood pressure cap:
    • generally do not CAP, though it is possibly reasonable to place a CAP of 180-200 depending on the clinical situation (e.g. active bleeding)
    • SBP < 90 doubles mortality (impairs CBP and exacerbates brain injury)
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ACUTE
CHRONIC
Operative management
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1. Burr holes vs. mini crani
2. MMA embolization
Medical management
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1. TXA + statins
2. steroids (help for unknown mechanism) - thought to stabilize membranes and have protective effects on cortex
 

Membrane

  • Local inflammatory reaction to bleed forms hematoma cavity with membranes within it --> clot liquefies over time causing collection to expand
Poorly
understoof pathology but may include recurrent microbleeds from dural
capillaries and hematoma membranes

MMA Embolization: complications

  • important to know these to counsel patients when consenting
    • dangerous anastomoses that can be embolized:
      • meningo-opthalmic variant → opthalmic artery
      • petrous branch of MMA → facial nerve geniculate ganglion
      • stylomastoid branch of posterior auricular artery → facial nerve geniculate ganglion
      notion image