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Subdural Haemorrhage (Clinical Presentation (Personality change,…
Subdural Haemorrhage
Clinical Presentation
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Signs of raised ICP e.g. headache, vomiting, nausea, seizure and raised BP
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Stupor, coma and coning may follow
Treatment
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Asess and manage ABCs, prioritise head CT
Aetiology
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Bridging veins bleed and form a haematoma between the dura and arachnoid - this reduces pressure and bleeding stops
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Epidemiology
Majority are from trauma, but usually forgotten as so long ago or minor
Chronic, apparent spontaneous SDH is common in elderly and also occurs with anticoagulants
Most common where patient has a small brain e.g. alcoholics, dementia, babies
Differential Diagnosis
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Stroke, dementia, CNS masses e.g. tumours or abscess
Key Facts
Caused by the accumulation of blood in the subdural space - between the arachnoid and dura mater following rupture of a BRIDGING VEIN between cortex and venous sinus (vulnerable to deceleration injury)
Considered very treatable in all those whose conscious level fluctuates and also in those having an 'evolving stroke' - especially if on anticoagulants
Risk Factors
Traumatic head injury, cerebral atrophy/increasing age - makes bridging veins more vulnerable
Alcoholism (causes cerebral atrophy), anticoagulation and physical abuse of infant
Diagnosis
CT head - diffuse spreading, hyper dense CRESCENT SHAPED collection of blood over 1 hemisphere
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