The csf mixes with varying amounts of blood, resulting in a thin xanthochromic fluid, sometimes termed a subdural hygroma 1. The authors present a toddler with sturgeweber syndrome who developed a subdural hematoma in the setting of a mechanical fall with minor head trauma. Prognosis of subdural hematoma depends upon many factors including the type of injury and the location of injury. Lee is scheduled to have burr holes and hematoma evacuation that afternoon. Dec 30, 2019 a subdural hematoma forms because of an accumulation of blood under the dura mater, one of the protective layers to the brain tissue under the calvarium. Its management is often equated clinically to that of the chronic subdural hematoma csdh. The leaking blood forms a hematoma that presses on the brain tissue. Increased intracranial pressure occurs when the inside of the skull experiences. Understanding subdural collections in pediatric abusive. Influence of patients age on symptoms, signs, and thickness of hematoma. Subdural hygromas refer to the accumulation of fluid in the subdural space. The subdural hematoma sdh is a potentially devastating. Understanding subdural collections in pediatric abusive head.
The incidence of subdural hematomas increases throughout life. In cases where a large amount of subdural blood accumulates, the pressure inside the head can lead to brain damage, unconsciousness, and death. Some sobering facts traumatic brain injury tbi is still the major cause of death under 45 years of age. Part of the advances in neurosurgery book series neuro, volume 8 the chronic subdural hematoma is defined as a clearly encapsulated accumulation of fluid between the dura and arachnoid membrane 11, generally occurring after slight brain trauma, often without apparent cause 2, 5, 11, 18, particularly in, elderly patients with brain atrophy.
Intracranial hematomas form when a head injury causes blood to accumulate within the brain or between the brain and the skull. We will go through1 epidemiology of tbi based on indian scenario2 pathophysiology of tbi3 cerebral vascular physiology in tbi. Diagnoses risk for ineffective breathing pattern,related to pressure on respiratory center by intracranial hematoma. There is an annual incidence of one to five cases per 100,000 population per year with a male to female ratio of 2. The presentation of subdural hematomas occurs on a spectrum, ranging from asymptomatic, mild headaches, or subtle cognitive decline to seizures and neurologic extremisherniation syndromes. Currently, the mainstay of treatment for csdh is surgical drainage, which has. Jan 09, 2018 epidural hematoma ie, accumulation of blood in the potential space between dura and bone may be intracranial edh or spinal sedh see the image below. Intracranial hematomas injuries and poisoning merck.
Epidural bleeding is often rapid because it is usually from arteries, which are highpressure. Increased intracranial pressure nursing pathophysiology nclex. After participating in this cme activity, the neurosurgeon should be better able to. Part of the advances in neurosurgery book series neuro, volume 8. Pathophysiology all sdh probably start out as acute subdurals. Cardiovascular medicine book dentistry book dermatology book emergency medicine book endocrinology book gastroenterology book geriatric medicine book. The chronic subdural hematoma is defined as a clearly encapsulated accumulation of fluid between the dura and arachnoid membrane 11, generally occurring after slight brain trauma, often without apparent cause 2, 5, 11, 18, particularly in, elderly patients with brain atrophy. Early prejudice against the simpler technique has gradually given way to the realization that one or two burr holes are an effective treatment for the chronic subdural hematoma. Subdural hematoma appears as crescentshaped hematoma. Many of those affected cannot recall a head injury. The usual mechanism that produces an acute subdural hematoma is a highspeed impact to the skull. Jimmy do went through a lifechanging experience in april 2002. Jones and dan miulli case study a 50yearold caucasian female was involved in a motor vehicle accident, during which she suffered a severe head injury, with initial glasgow coma scale gcs score of 10, and worsening. Hospital costs, incidence, and inhospital mortality rates of traumatic subdural hematoma in the united states clinical article paul kalanithi, m.
This network of neurons and neuronal connective tissue is prone. Subdural hematoma definition of subdural hematoma by. Pathophysiology of the development of csdh clear yellow to dark, thin liquid to semisolid gardner 1932,osmotic gradient theory increase protein content increase oncotic pressure weir csdh fluid to be isosmotic to blood and csf microscopic examination of fluid from csdhs of any age. Chronic subdural hematoma neurosurgery oxford academic. Debbie yi madhok, coauthor of update on the ed management of intracranial hemorrhage april 6, 2018. In the pediatric patient, trauma is the most common cause of. The understanding of subdural hematoma relies on the knowledge of neuroanatomical sheets covering the brain. There in a high variance in the treatment in literature. Intracranial hemorrhage subarachnoid bleeding subdural bleeding. Pathogenesis and pathophysiology of chronic subdural. Dec 07, 2018 intracranial hemorrhage ie, the pathological accumulation of blood within the cranial vault may occur within brain parenchyma or the surrounding meningeal spaces. Chronic subdural hematoma csdh is one of the most common clinical entities in daily neurosurgical practice which carries a most favorable prognosis.
However, their neurological deterioration is usually rapid, which seems to align them with acute subdural hematoma asdh. Epidemiology subdural hygromas are encountered in all a. Chronic subdural hematoma is fundamentally a disorder of the meningeal blood vessels embolization of the middle meningeal artery mma has recently been proposed as a curative treatment for chronic subdural hematoma csdh, but evidence for the indication and timing is not definitive. When an 18wheeler cut him off in traffic, he lost control of the car he was driving and was involved in a rollover accident. Subdural hematoma can be classified as the acute or the chronic form, with immediate or delayed symptom onset, respectively. Diagnosis is suspected clinically and confirmed by imaging primarily ct. This occurs when blood vessels usually veins rupture between your brain and the outermost of three membrane layers that cover your brain dura mater. Series study of sub acute and chronic subdural haematoma. She was intubated at the accident scene, and brought. Chronic subdural hematoma is a frequently encountered entity in neurosurgery in particular in elderly patients. Subdural hematoma is usually caused by a head injury, such as from a fall, motor vehicle collision, or an assault. Acute subdural hematomas often follow head trauma forceful enough to temporarily knock someone unconscious. Hemorrhage within the meninges or the associated potential spaces, including epidural hematoma, subdural hematoma, and subarachnoid hemorrhage, is covered in detail in other articles.
A guide for patients and families 2 since the skull does not expand, any buildup of blood inside it can quickly put pressure on the brain. Delayedonset posttraumatic headache after a motor vehicle. Although a few cases of intracranial hemorrhage in patients with sturgeweber syndrome have been reported, prior reports have not discussed this complication with regard to particular therapies. Chronic subdural hematoma csdh is one of the more frequent pathologic entities in daily neurosurgical practice. The preferred surgical method continues to attract debate. A common variant of the abusive head trauma is the shaken baby syndrome. For the past 20 years or so, most neurosurgeons have learned that burr holes are just as effective as a craniotomy for the management of the chronic subdural hematoma. Traumatic brain injury tbi is physical injury to brain tissue that temporarily or permanently impairs brain function.
Outcomesresolutions nearly 90% of the individuals regain their lost function and improve, if the hematoma is evacuated promptly. Subdural hematoma definition a subdural hematoma is a collection of blood in the space between the outer layer dura and middle layers of the covering of the brain the meninges. There is lack of uniformity about the treatment strategies, such as the role of burr hole, twist drill, craniotomy, etc. Computed tomography or magnetic resonance imaging is used to detect an intracranial hematoma. Gordon deen, in neurology and clinical neuroscience, 2007. Subdural hematoma an overview sciencedirect topics. Studies evaluating this novel method by gazzeri et al.
Subdural hematomas form between the dura and the arachnoid membranes epidural hematomas arise in the potential space between the dura and the skull the prognosis and management of sdh will be discussed here. Initial treatment consists of ensuring a reliable airway and maintaining adequate ventilation, oxygenation, and blood pressure. It is a misconception that an operation is rarely necessary in head injury. Chronic subdural hematoma is characterized by a well defined and encapsulated collection between the dura mater and arachnoid membranes containing a mixture of fluid and coagulated blood in various stages 5, 6.
A catalogue record for this book is available from the british library. Intracranial hematoma symptoms and causes mayo clinic. Pathophysiology and epidemiology of traumatic brain injury. Epidural haematoma extradural haemorrhage slideshare. Head injury definition a history of a blow to the head or the presence of a scalp wound or those with evidence of altered consciousness after a relevant injury. The brain is the central repository of delicate neural tissue. Chronic subdural haematoma csdh is an encapsulated collection of blood and fluid on the surface of the brain. Subdural hematoma sdh a guide for patients and families. Hospital costs, incidence, and inhospital mortality rates. Computed tomographic head scan shows bilateral subdural hematomas with acute and chronic components. A guide for patients and families 3 subacute subdural hematomas are ones found within 37 days of an injury. The chronic phase of a subdural hematoma begins several weeks after the first bleeding. The aim of this clinical study is to evaluate the patients with unilateral and bilateral recurrent chronic subdural hematoma. The authors suggested that in patients with a history of trauma that present with intermittent hemiparesis even in the absence of signs of raised intracranial pressure, chronic subdural hematoma should be strongly suspected.
Medicine and surgery are among options used as treatments for hematoma. The knowledge of the pathophysiology after traumatic head injury is necessary for adequate and patientoriented treatment. Subdural hematomas are seen in 1020% of patients with head trauma young and destian, 2002. Update on the ed management of intracranial hemorrhage. Summary of the pathophysiological processes involved in the formation of a csdh. It is important to distinguish between a closed skull fracture with. Verploegh, bsc, victor volovici, md, ruben dammers, md, phd, and lotte m. Traumatic brain injury tbi msd manual professional edition. A clear history of injury or trauma should be sought in the presence of an acute or chronic subdural hematoma. Hypertension is still the main cause, being responsible for approximately 55% of cases of ich. Subdural hematoma is a condition of collection of blood outside the brain. Historically considered a result of head trauma, recent evidence suggests there are more complex processes involved.
Subdural hematoma is a common injury in both military active duty and their dependents, including children subject to nonaccidental trauma. The head trauma that causes chronic subdural hemorrhage is often minor. Nursing care plan a client with a subdural hematoma. Chronic subdural hematomas may take weeks to months to appear. A subdural hematoma results from the stretching and tearing of bridging cortical veins in the subdural space, a potential space between the pia arachnoid and the dura figs 22. A subdural hematoma is a collection of blood that forms on the surface of the brain. The diagnosis of a subdural hematoma is made, and mr. As the primary insult, which represents the direct mechanical damage, cannot be therapeutically influenced, target of the treatment is the limitation of the secondary damage delayed nonmechanical damage. Pdf chronic subdural haematoma csdh is an encapsulated collection of blood and fluid on the surface of the brain.
Inflammation, angiogenesis and implications for pharmacotherapy article pdf available in journal of neuroinflammation 141 may 2017 with 1,034. Subdural hematoma bleeding into the subdural space results from cerebral contusions, damaged vessels in the pia mater, or from torn emissary veins. The hematoma can be seen on autopsy as brick red, or as radiolucent on ct scan, because of heatinduced coagulation of the hematoma. Pathophysiology and nonsurgical treatment of chronic subdural. Blood within the subdural space evokes an inflammatory response. Helps identify subacute subdural hematoma which is isodense and more difficult to distinguish. Chronic subdural hematoma csdh is one of the most common neurosurgical conditions. Pathophysiology of chronic subdural hematoma longdom. Mahapatra, 9789380704760, available at book depository with free delivery worldwide. Mar 01, 2000 sdh has been referred to as the great neurologic imitator. In contrast to an epidural hematoma, it is usually somewhat irregular in shape and slightly concave. Causes of intracerebral haemorrhage table 1 lists the various causes of ich.
A chronic subdural hematoma is an old collection of blood and blood breakdown products between the surface of the brain and its outermost covering the dura. Middle meningeal artery embolization for chronic subdural. It is one of the most common forms of intracranial hemorrhage, being considered a benign lesion, though chronically progressive, but in. A subdural hematoma sdh is a common neurosurgical disorder that often requires surgical intervention. Evidencebased treatment of chronic subdural hematoma. The incidence of subdural hematoma is estimated to be between 5% to 25% of patients with a significant head injury. However, because of the advanced age and medical problems of patients, surgical therapy is frequently associated with various complications.
The third type of subdural fluid accumulation is purulent. Nov 02, 2015 epidural haematoma extradural haemorrhage 1. Subacute subdural hematoma sasdh is an entity which is yet to capture the popular imagination among the neurosurgeons. Oct 11, 2019 chronic subdural hematoma is fundamentally a disorder of the meningeal blood vessels embolization of the middle meningeal artery mma has recently been proposed as a curative treatment for chronic subdural hematoma csdh, but evidence for the indication and timing is not definitive. A subdural hematoma forms because of an accumulation of blood under the dura. The sudden blow to the head tears blood vessels that run along the surface of the. Subacute subdural hematoma sasdh is an entity which is yet to gain popular foothold among treating neurosurgeons. What is the prognosis of chronic subdural hematoma. The chronic subdural hematoma is defined as a clearly encapsulated accumulation of. Acute subdural hematoma asdh is a common occurrence following severe head injury. If a subdural hematoma is large and is causing symptoms. Intracranial epidural hematoma occurs in approximately 2% of patients with head injuries and 515% of patients with fatal head injuries.
Abstractchronic subdural hematoma is a frequent type of hemorrhage, which terminates with mortality if not diagnosed and treated early. Description subdural hematomas most often affect people who are. Chronic subdural haematoma is defined as a fluid collection within the layers of duramater 1. The hematoma initially appears as a long, hyperdense margin close to the skull 8 in fig. It usually results from tears in bridging veins that cross the subdural space. Pathogenesis and pathophysiology of chronic subdural haematoma. A subdural hematoma forms because of an accumulation of blood under the dura mater, one of the protective layers to the brain tissue under the calvarium. Lifethreatening physical abuse of infants and toddlers is frequently correlated with head injuries. Neurotrauma is a common presentation in emergency departments across the world and is often an. Pathophysiology and manifestations when pathogens enter the cns and the meninges, an inflam.
Epidural hematoma extradural haematoma symptoms and treatment see online here this article provides a brief overview of neurotrauma, its classi. In 10% of cases, however, it comes from veins and can progress more slowly. Chronic subdural hematoma may manifest with increasing daily headache, fluctuating drowsiness or confusion. The second type of subdural fluid collection occurs after an opening in the arachnoid, which allows csf to enter the subdural space. The slow development of clinical symptoms is a characteristic feature. Within days, fibroblasts invade the clot, and form neomembranes on inner cortical and outer dural surface. Symptoms may be insidious and nonspecific, and a history of head trauma is often lacking. This book is distributed under the terms of the creative commons. Acute and chronic subdural fluid collections are common problems during infancy. Atraumatic subdural hematoma and subdural hygroma are briefly addressed. Undiagnosed or untreated individuals with chronic subdural hematoma may notice a. It is most often caused by torn, bleeding veins on the inside of the dura as a result of a blow to the head. A subdural hematoma sdh is a type of bleeding in which a collection of blood usually associated with a traumatic brain injury gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. An enlarging hematoma can cause gradual loss of consciousness and possibly death.
Subdural hematoma sdh and epidural hematoma are characterized by bleeding into the spaces surrounding the brain. This network of neurons and neuronal connective tissue is prone to. Subtle presentations include mild headache, subtle mental status change, and gait disturbances. The blood may press against the brain and damage the tissue. This is followed by in growth of neocapillaries, enzymatic fibrinolysis and liquefaction of blood clot. Subdural hematoma is the result of bleeding over the surface of the brain, beneath the dura. Sometimes surgery is needed to drain blood from a hematoma.
Sep 26, 2012 pathophysiology and epidemiology of traumatic brain injury 1. Not all head bleeds are the same september 4, 2017. Case report of subdural hematoma in a patient with sturge. This causes brain tissue to accelerate or decelerate relative to the fixed dural structures, tearing blood vessels. As this is below the dura, the subdural hematoma follows the surface of the brain. Textbook of traumatic brain injury book depository. A client with a subdural hematoma continued icp monitor is inserted and reveals increased intracranial pressure. Pdf chronic subdural hematoma csdh is one of the most common neurosurgical conditions. In many cases, it is considered an epiphenomenon of head injury when it is called a traumatic subdural hygroma. Early diagnosis and rapidly executed treatment for acute subdural hematomas strikingly improve outcome. Essentials of radiology study guide the essentials of radiology examination is designed to test the radiology knowledge and clinical skills across both the subspecialties and imaging modalities of diagnostic radiology for the imaging diagnosis of conditions that may be encountered in the practices of all radiologists. Acute subdural hematoma usually occurs after severe, highimpact injuries and is often associated with contusions of the adjacent areas of the brain. The study group consisted of cases with unilateral and bilateral recurrent chronic subdural hematomas who underwent aggressive wide. It is a type of intracranial hemorrhage that occurs beneath the dura essentially, a collection of blood over the surface of the brain and may be.