SYB 2

1
SYB 2

• Marni Scheiner
• MS IV

2
What kind of image is this, and what do you see?
3
Subdural Hematoma

• Typically following head trauma (falls/assaults)
• May follow minor trauma
• Acceleration/Deceleration Injury
• Rupture of bridging veins
• Accumulation of blood between the dura and
  arachnoid membranes
• Common in elderly, babies (shaken baby syndrome)
  and alcoholics.
• http//www.sbsdefense.com/images/Meninges1.jpg

4
Subdural Hematoma

• Signs and symptoms
• As quick as 24 hrs, but may appear as much as 2
  weeks later.
• Vein hemorrhage lower pressure than arteries (in
  epidural hematomas)bleed more slowly
• H/x of recent head injury/fall
• LOC/ change in mental status/delerium/dementia
• Seizure
• Headache
• N/V
• Personality changes
• Slurred speech, inability to speak
• Ataxia
• Blurred vision
• If large enough, may cause signs of increased ICP
  or damage to part of the brain will be present.

5
Subdural Hematoma

• 3 subtypes (depend on speed of onset)
• Acute
• due to trauma
• Most severe if associated with cerebral contusion
• most lethal of all head injuries -- high
  mortality rate (20-50)if they are not rapidly
  treated with surgical decompression.
• Subacute
• 3-7 days after acute injury
• Chronic
• 2-3 weeks after acute injury
• often after minor head trauma (50 pts have no
  identifiable cause)
• Slow bleed, repeated minor bleeds, and usually
  self limited
• Small subdural hematomas (lt1cm wide) have much
  better outcomes than acute subdural bleeds

6
Radiographic Signs of Subdural Hematoma

• MRI vs CT
• MRI better for size and effect on brain.
• Non-contrast CT is primary means of making a
  diagnosis and eval for treatment.
• Non-contrast Head CT
• General
• Crosses the suture lines, but not the dural
  reflections (DOES NOT CROSS THE MIDLINE)
• Moderate/large size cause midline shift.
• Look for edema, may indicate future herniation
• Usually no skull fracture

7
Radiographic- Subdural

• Noncontrast Head CT
• Acute
• hyperdense, crescentic shaped
• Most common area parietal region, and above the
  tentorium cerebelli
• Sub-acute
• Isodense (with respect to brain)
• More difficult to see with non-contrast.
  Contrast-enhanced CT or MRI recommended for
  imaging 48-72 hrs after injury.
• Chronic
• Hypodense, easy to see on non-contrast head CT
  scan.

8
Pathophysiology

• Collected bood--gt draw in water
  osmotically--gtbrain expansion--gt compression of
  brain tissue--gt new bleeds/tearing other blood
  vessels.
• Sometimes, arachnoid layer is torn--gt CSF and
  blood both expand in the intracranial space--gt
  increasing ICP.
• If self-limited The body gradually reabsorbs the
  clot and replaces it with granulation tissue.

9
Treatment

• Depends on hematoma size and rate of growth.
• Small subdural hematomas
• careful monitoring until the body heals itself
• Large or symptomatic hematomas
• Craniotomy (open skull, remove blood clot, and
  control site of bleeding)
• Post-op complications
• increased ICP, brain edema, bleeding, infection,
  and seizure.