subdural haemorrhage

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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.

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.

• 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 haemorrhage

Bleeding between the DURA MATER and the underlying ARACHNOID MATER. See SUBDURAL HAEMATOMA.
References in periodicals archive ?
(ICH = intracerebral haemorrhage; VH = ventricular haemorrhage; EDH = extradural haemorrhage; SDH = subdural haemorrhage; SAH = sub-arachnoid haemorrhage.) Depressed space 12% Contusion 13% ICH 3% VH 1% EDH 7% SDH 2% SAH 10% Free air 3% Others 49% Note: Table made from pie chart.
"I have no doubt that his subdural haemorrhage has been caused by a fall - whether it has been by epileptic seizure, which on balance is more likely than not, or a fall because he was possibly intoxicated, is irrelevant.
During the specified period, 10 patients on acetylsalicylic acid with the following conditions were enrolled: intracerebral haemorrhage (N = 3), cerebral infarctions (N = 2), traumatic brain injury with contusion or acute subdural haematoma (N = 2), spontaneous subarachnoid haemorrhage with hydrocephalus (N = 1), and chronic subdural haemorrhage (N = 2).
A post-mortem found Mr Haigh had died from a subdural haemorrhage sustained in a fall.
Khajuria et al also noticed the similar findings; Subdural Haemorrhage 79.31%, Subarachnoid Haemorrhage 63.33%, Extradural Haemorrhage 48.85%, Intra-cranial injuries 21.26%, and Contusion 35.63% of the victims.
He said Dennis either had "a simple fall or a heart attack, brought on by the shock of seeing Nancy collapsed", which saw him hit his head, giving him a subdural haemorrhage - killing him.
Mr Robertson went on: "As regards these fatal injuries inside the head, what is your response to the suggestion that all those injuries, the subdural haemorrhage and bleeding, the neuro damage - could it be caused by a fall to the ground?" Dr Hamilton said: "A simple fall, even an accelerated fall, doesn't explain all of the injuries."
Non-accidental head injury (NAHI) occurs in approximately 12% of cases of physical abuse in children.(2) In the absence of significant trauma, a skull fracture in an infant, as in our patient, suggests a higher likelihood of NAI.(3) Subdural haemorrhage (SDH) and subarachnoid haemorrhage (SAH) are common abusive injuries.(2) Shaking of the infant results in angular acceleration and deceleration shear forces that may tear the cortical bridging veins, resulting in SAH or SDH.(4) SAH may also occur from direct contact forces which cause tearing of vessels.(2)
The cause of death was a subdural haemorrhage consistent with a fall, but the coroner recorded an open verdict as there was no explanation to how it happened.
Instead he suffered internal bleeding, and the extent of his injury was only discovered later that day, when doctors found he had a subdural haemorrhage.
A CT brain scan showed a right frontal intracerebral haemorrhage with some associated mass effect, but no midline shift and a small left occipital subdural haemorrhage (Figure 1).
A post mortem found he died of an acute subdural haemorrhage caused by a cattle accident.