This is the CT of the Brain of a 68 year old man who was admitted to the Neurosurgery ward at around 10.00 pm in the night after a history of falling in his house.At the time he was brought to the Hospital he was confused.Comment On this CT Brain and How would you Manage this Patient?

ANSWER - ACUTE SDH IN THE LEFT FRONTO PARIETAL REGION OF THE BRAIN 


Acute subdural hemorrhage  is a type of hematoma, a form of traumatic brain injury in which blood collects within the subdural space in between the inner meningeal layer of the dura matter and the arachnoid matter.It results from rupture of cortical bridging veins that connect the venous system of the brain to the large intradural venous sinuses.Acute subdural hematoma has a very high mortality rate.

Predisposing factors
  • Violently shakes an infant or small child- classical finding in Shaken baby syndrome or Battered Baby Syndrome
  • cerebral atrophy, e.g. elderly
  • Low CSF pressure after shunting
  • Alcoholism
  • Coagulation disorder or anticoagulation therapy

CLINICAL FEATURES
  1. Loss of consciousness or fluctuating levels of consciousness
  2. Focal neurological signs
  3. Signs of increased ICP
  4. At the End stage, signs of Brain Stem herniation

INVESTIGATIONS
  • CT scan is mandatory
CT scan, subdural hematomas are classically crescent-shaped, with a concave surface away from the skull
Initially it is become hyperdense and  after 10-20 days, the subdural hematoma becomes isodense with brain. Later it becomes relatively hypodense
Mid line Shifting with compressed ipsilateral ventricle and dialated contralateral ventricle due to obstruction at the foramen of Munro
  • Skull X-ray 

MANAGEMENT
  • Large or symptomatic hematomas require a craniotomy
  • Evacuate hematoma through 2-3 burr holes, and irrigate cavity with saline
  • In infants,evacuate haematoma through the anterior fontanelle
  • Identifies and controls sites of bleeding
  • Conservative management - steroid treatment over several weeks if it is small.
Postoperative complications include increased ICP, brain edema, infections,seizure and rebleeding

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10 comments

  1. Anonymous Says:
  2. subdural hematoma

     
  3. Anonymous Says:
  4. -hyperdense lesion on the right side
    -hyperdense lesion is crescent shape
    -hyperdense lesion intraparenchymal

    clinical and ct brain scan suggestive of subdural hemorrhage and intraparenchymal hemorrhage

     
  5. Anonymous Says:
  6. -hyperdense lesion on the right side
    -hyperdense lesion is crescent shape
    -hyperdense lesion intraparenchymal
    -midline shift

    clinical and ct brain scan suggestive of subdural hemorrhage and intraparenchymal hemorrhage

    -Mx resuscitation ABC
    -craniotomy or burrhole

     
  7. Anonymous Says:
  8. Right subdural haematoma with cerebral edema
    There is midline shift with minimal intraparenchymal bleed on the right side
    Ventricles on the right are compressed
    there is sign of cerebral atrophy on the left

     
  9. Anonymous Says:
  10. Is there a mid line shift here?Its difficult to see in this ,isnt it?

     
  11. Anonymous Says:
  12. how to differentiate subdural and epidural hematoma in ct scan? subdural hematoma will cause more brain damage right.. and both oso push midline right?
    sorry to ask so many question. i goggle it,but not much help..

     
  13. Anonymous Says:
  14. to differentiate btwn subdural n extradural,look at the shape of hyperdense lesion.in subdural hematoma,there is a crescent/convex shape hyperdense lesion,whereas in extradural there is a concave shape of hyperdense lesion.
    basically both will cause midline shift,but its happen more with subdural hematoma

     
  15. Anonymous Says:
  16. i think in this ct scan,there is a minimal midline shift

     
  17. Anonymous Says:
  18. correction about extradural n subdural above:
    subdural: concave hyperdense lesion
    extradural: convex hyperdense lesion
    sorry for the inconvenience :)

     
  19. neurosurgery Says:
  20. it's a kind of subdural hematom. it's common in eldery people that have head trauma

     

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