Involved vessel temperoparietal locus most likely middle meningeal artery frontal locus anterior ethmoidal artery occipital locus transverse or sigmoid sinuses. Figures 1, a and b noncontrasted brain ctscan showing a left hemispherical subdural collection with mass effect figure 2, a and b there is an interhemispherical frontoparietal hemorrhagic collection, which extends toward the right side of the tentorium. Chronic subdural hematomas may take weeks to months to appear. Subdural hematoma sdh a guide for patients and families. Many of these lesions require immediate evacuation, regardless of the time of dayordayoftheweek. Brainstem hemorrhage secondary to evacuation of chronic. Pathologically, it is usually associated with or, for that matter, secondary to cerebral contusion and laceration. A prospective study of chronic subdural haematomas in elderly patients. Subdural hemorrhage sdh also commonly called a subdural hematoma is a collection of blood accumulating in the subdural space, the potential space. All ihsdh was hyperdense in ct at the time of diagnosis.
Csdhs are common neurosurgical problems and treatment includes evacuation of the hematoma by burrhole drainage. A ct scan will usually detect significant subdural hematomas. Cerebral saltwasting describes the findings of hyponatremia and excessive renal sodium excretion in patients with various affections of the central nervous system cns. Patient presentation a 4monthold female was referred to the pediatric intensive care unit after she presented with 9 days of emesis. Assessment when saundra knight, the nurse on the neurosurgical unit, enters the room, she notices that mr. The presence of retinal hemorrhages, bone and rib fractures, delay in presentation and the young age of the infants, suggests child abuse is the most likely cause of these injuries. A subdural hematoma sdh happens in the space between the covering of brain the dura and the brain. Rapid spontaneous resolution of traumatic acute subdural hematoma is an infrequent phenomenon and mainly develops in a case of simple acute subdural hematoma without parenchymal contusion. Hematoma epidural y subdural by azael limon on prezi. We present a rare case, which did not require an open surgery, i. Subdural hematoma of nontraumatic origin the medicolegal investigation of sudden, unexpected or violent deaths due to intracranial hemorrhage results in. The onset of symptoms may be acute, subacute, or chronic. Spontaneous chronic subdural haematomas csdhs are rare, especially in young adults.
Epidural hematoma edh, also known as extradural hematoma, is a hemorrhage into the space between the dura and the overlying calvarium. There in a high variance in the treatment in literature. Sometimes you may not remember hitting your head at all. Subdural hematomas in infants with benign enlargement of. Magnetic resonance imaging mri scan is more sensitive in the diagnosis of bilateral isodense csdh, multiple loculations, intrahematoma membranes, fresh. Location between the skull and the inner meningeal layer of the dura mater or between outer endosteal and inner meningeal layer of dura mater. Subdural hematoma is the most common type of traumatic intracranial mass lesion. It usually results from tears in bridging veins that cross the subdural space subdural hematomas may cause an increase in the pressure inside the. The prognosis and management of sdh will be discussed here. Natural history of acute subdural hematoma vcu scholars. Subdural hematoma cranial nerves traumatic brain injury medical science human mind neurology anatomy and physiology nervous system education.
The patient is a 34yearold woman whose initial presentation of widely metastatic. The etiology of subdural hematomas is commonly attributed to head injury 22, 23. Subdural hematoma, bleeding into the space between the brain and its outermost protective covering, the dura. Once in stable condition, jimmy was transferred to tirr memorial hermann to complete a month of inpatient rehabilitation therapy.
The symptoms of a subdural haematoma can develop soon after a severe head injury, or gradually over days or weeks after a more minor head injury. The preferred surgical method continues to attract debate. Subdural hematoma acute subdural hematomas occur when outside forces such as the impact from a motor vehicle accident or blunt force trauma cause the brain to rapidly accelerate and decelerate inside the skull. Symptoms of sdh include headaches, changes in mental status, and focal neurologic deficits. Subdural hematoma knowledge for medical students and. Hospital costs, incidence, and inhospital mortality rates. Many of those affected cannot recall a head injury. Spontaneous chronic subdural hematoma of the posterior fossa. Early diagnosis and rapidly executed treatment for acute subdural hematomas strikingly improve outcome. Rapid resolution of acute subdural hematoma in child with. Asghar m, adhiyaman v, greenway mw, bhowmick bk, bates a. The subdural hematoma sdh is a potentially devastating. However, it has been rarely reported in a pediatric case with severe initial head injury. A subdural hematoma occurs when a vein ruptures between your skull and your brains surface.
A subdural haematoma is a blood clot that forms between layers in the protective coverings of the brain meninges, when veins tear as a result of sudden movement of the brain against the skull. A guide for patients and families 3 subacute subdural hematomas are ones found within 37 days of an injury. Chronic subdural haematoma in the elderlya north wales experience. Movement of the brain stretches the blood vessels that connect the surface of the brain to the dura, the sheet of tissue between the brain and the skull. The expanding hemorrhage can increase the pressure inside the skull and compress the underlying brain tissue. Chronic subdural hematoma sdh in the elderly population is a common problem encountered in neurosurgical practice.
Subdural hematoma rebleeding in relation to abusive head. Chronic subdural hematoma csdh is one of the most common neurosurgical conditions. Tentorialperitentorial subdural hemorrhage rare, but this is what they look like on ct. Subdural hematomas are a wellknown entity in neurosurgical practice. The acute type of subdural hematoma occurs in 5% to 22% of patients with severe head injuries. The acute type is most common in people younger than 60. The morbidity and mortality result from mass effect on the brain as the hematoma grows and strips the dura away from the skull. A subdural hematoma sdh is a type of bleeding in which a collection of bloodusually associated with a traumatic brain injurygathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. Chronic subdural hematoma csdh refers to collection of old blood between the dura matter and the arachnoid matter subdural space. If a subdural collection has mixed density with areas of both high and low attenuation, it is often thought to be a chronic sdh, with the high. Here we report a case of subdural hematoma as the first presentation of choriocarcinoma.
Clinical symptoms develop 16 days or more after injury when hematoma is enlarged by absorption of fluids from surrounding tissue by osmosis andrews, 2003. In 5 cases, there was no recognized trauma before identification of the subdural hematoma. During the study period, 7 patients with bess complicated by subdural hematoma were identified. Multiple contralateral recurrence of bilateral chronic subdural. A 7yearold asian girl with traumatic acute subdural hematoma was transferred to our hospital for an. Operative procedure is generally considered the treatment of choice for chronic subdural hematoma. Formerly, these electrolyte alterations in patients with cerebral disease were ascribed to. A subdural hematoma forms because of an accumulation of blood under the dura mater, one of the protective layers to the brain tissue under. A subdural hematoma sdh is a collection of blood below the inner layer of the dura but external to the brain and arachnoid membrane see. Chronic subdural hematoma presents a distinct clinical problem from acute trauma to the brain. Their mean age at identification of the subdural hematoma was 7.
Valadka, md introduction few emergencies in neurosurgery are as worrisome as a large acute subdural hematoma asdh fig. Life threatening hyponatraemia following evacuation of. The disorder acute and chronic is more common in males than in females. As a reminder, the tentorium is an extension of the dura. Acute subdural hematomas sdh have been classically described on ct as homogeneous, highdensity, extracerebral collections of blood with a crescentic configuration. It is caused by head trauma that results in a tear in the bridging vein, which connects the superficial cerebral veins to the dural venous sinuses. Subdural hematomas form between the dura and the arachnoid membranes epidural hematomas arise in the potential space between the dura and the skull. However, in about half of the cases, there is no definite history of head injury. Nursing diagnosis for subdural hematoma with images. Acute subdural hematoma anticoagulation computed tomography glasgow coma scale mri. It is usually caused by some kind of direct blow to the head as a result of a fall, an assault or a road accident. With the chronic subdural hematoma, the onset of the symptoms is remote in time from the original trauma, which is usually trivial.
In patients with an acute sdh, clot thickness or volume and the mls on the preoperative ct correlate with outcome. A subdural hematoma is a collection of blood that forms on the surface of the brain. It is a misconception that an operation is rarely necessary in head injury. Nonaccidental injury is the commonest cause of subdural hematomas in children under 2 years of age. Admissions for traumatic sdh increased 154% from 17,328 in 1993 to 43,996 in 2006. Chronic subdural hematoma in adult and elderly patients. The blood may press against the brain and damage the tissue. To characterize patients with chronic subdural hematoma undergoing surgery and to. In studies analyzing ct parameters that may be predictive for delayed surgery in patients undergoing initial nonoperative management, an mls greater than 5 mm or a clot thickness greater than 10 mm on the initial ct scan emerged as significant prognostic factors see appendices. Chronic subdural hematoma is a frequently encountered entity in neurosurgery in particular in elderly patients. Natural history of acute subdural hematoma rafael a. There is lack of uniformity about the treatment strategies, such as the role of burr hole, twist drill, craniotomy, etc. Subdural hematoma sdh and epidural hematoma are characterized by bleeding into the spaces surrounding the brain. A subdural hematoma sdh is a type of bleeding in which a collection of bloodusually associated with a traumatic brain injurygathers between the inner.
Diverse sequelae of central nervous system metastasis of choriocarcinoma have been reported, including infarction, intra or extra axial hemorrhages, aneurysm formation and carotidcavernous fistula. She was seen by a local health care provider who admitted her locally. Ihsdh frequently accompanied convexity subdural hematoma. A subdural hematoma sdh is a type of bleeding in which a collection of blood usually associated with a traumatic brain injurygathers between the inner. It typically results when a traumatic force applied to the head creates significant fastchanging velocities of the contents inside the skull. She initially began vomiting once per day but this increased to several times per day over 34 days. A chronic subdural hematoma may happen in older people after a minor head injury. The head trauma that causes chronic subdural hemorrhage is often minor. Acute subdural haematoma is a wellentrenched nosological entity implying subdural collection of blood following acute head injury. Between the meningeal layers of dura mater and the arachnoid mater. The diagnosis of a subdural hematoma is made, and mr. Glucocorticoids in the treatment of chronic subdural hematoma.
The incidence of chronic sdh has been reported as 1. They may resemble intraparenchymal bleed on ct but mri can confirm exact location with regard to the tentorium. If you sustain a major brain injury, this area can fill with blood and. Subdural hematoma sdh refers to bleeding between the dura mater and arachnoid membrane. Acute subdural hematoma asdh is a common occurrence following severe head injury. Subdural hematoma is a common injury in both military active duty and their dependents, including children subject to nonaccidental trauma. Clinical features of interhemispheric subdural hematomas ncbi. Subdural hematoma nursing diagnosis head injury fabrics. Postoperative complications though rare, include reaccumulation, rehemorrhage, cerebral edema, infection, seizures, and intracerebral hemorrhage ich. A subdural hematoma sdh is a collection of blood below the inner layer of the dura but external to the brain and arachnoid membrane see the images below. A subdural hematoma may happen after a severe head injury. Cost and incidence of traumatic subdural hematoma 1015 admission increased substantially fig.
503 1010 184 395 295 1304 1109 286 8 567 1521 1379 721 1539 1098 517 919 330 1356 591 168 537 916 1099 233 647 487 1217 280 321 355 1635 752 1101 137 1137 489 52 388 808 488 1396 644 1275 1288 31 1147 766