subdural haematoma


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subdural haematoma

Subdural haematoma, aetiology
Acute SDH
Caused by tearing of communicating veins which traverse the subdural space, or more rarely the sinuses, due to a change of velocity of the head (acceleration or deceleration), often with some rotational movement. The site of original haemorrhage is not usually identified.

Sites
Lateral surface of a cerebral hemisphere, often in a parasagittal position. After blunt impact, the SDH may not be situated under the site of impact. The blood may move following accumulation.

Chronic SDH
May expand due to rebleeding or osmosis of CSF into the centre of the heamatoma; it may also be resorbed or stay the same size. The colour changes from dark red to brown between days 5 and 12.
Cellular infiltration occurs within a few hours; a neomembrane formed adjacent to dura which is a few cells thick in 4 days. Fibroblasts from the membrane enter the clot at 5–8 days.

Day 15: Membrane is present under the clot.
1–3 months: Hyaline appearance to membrane.
6–12 months: Thick, fibrous membrane, like dura.

Trauma
• Rapid acceleration/deceleration (with tearing of  dural bridging veins);
• Minor trauma in setting of cerebral atrophy;
• Birth trauma in neonates.

Dural neoplasms
• Meningiomas
• Metastases

Abnormal haemostasis.

subdural haematoma

A dangerous complication of head injury in which bleeding occurs from tearing of one of the blood vessels under the DURA MATER. The blood gradually accumulates to form an expanding clot which slowly compresses the brain. After recovery of consciousness from the original injury there is typically a relapse into coma some time later. Treatment, which is life-saving, involves opening the skull and tying off the bleeding vessel.
References in periodicals archive ?
According to the doctor, "Eighty per cent of those who suffer from subdural haematoma lose their lives, if they do not receive prompt treatment.
Dexmedetomidine versus Propofol Along with Scalp Block for Chronic Subdural Haematoma Evacuation Under Monitored Anaesthesia Care: Which is Better?.
Risks in any accident like this are concussion or even a subdural haematoma following a head injury.
Kong et al., "Intracranial subdural haematoma after unintended durotomy during spine surgery," Canadian Journal of Anesthesia, vol.
McAuliffe, "Acute spontaneous spinal subdural haematoma: MRI features," Neuroradiology, vol.
Similarly, expansion of acute subdural haematoma, concomitant development of parenchymal lesions, expansion of contusion, recurrent bleed in resected contusion bed, re-expansion of intra-cerebral haemorrhage as well as recurrent or new onset intra-cranial haematoma in patients operated upon for depressed skull fracture are one of the most dreaded clinical entities which may affect the clinical course of a patient who has already been operated and recovering in the ward4,5.
Epidural haematoma after evacuation of contralateral subdural haematoma. Ir J Med Sci 2004;173:217-8.
Conclusion: The recurrence is significantly less with the use of a drains after burr-hole drainage of chronic subdural haematoma.
These include gradual and graded decompression of the chronic subdural haematoma (Especially for large collections) and careful control of blood pressure liability in the perioperative period.
Infantile subdural haematoma and its relationship to whiplash injuries.