Evidencebased treatment of chronic subdural hematoma. Patients who have benign enlargement of the subarachnoid spaces. A subdural hematoma occurs when a vein located beneath the skull ruptures and starts to bleed. The pathophysiology of brain swelling associated with. Subdural hematoma free download as powerpoint presentation. Pdf subdural hematoma is a common injury in both military active duty and their dependents, including children subject to nonaccidental trauma. Subdural hematomas in infants with benign enlargement of the subarachnoid spaces are not pathognomonic for child abuse p. Series study of sub acute and chronic subdural haematoma. Epidural hematoma is when bleeding occurs between the tough outer membrane covering the. The injury can be due to accidental fall, motor vehicle collision, or it can be a heavy blow to the head. Subdural hematoma definition of subdural hematoma by. Its protean manifestations make its inclusion in the differential diagnosis of encephalopathy practically mandatory, especially when there is a history of trauma. Trotter,1 in 1914, first emphasized the traumatic etiology of virchows pachymeningitis hemorrhagica interna. The hematoma and swelling can result in increased pressure within the skull intracranial pressure, which can make symptoms worse and increase the risk of dying.
Subdural hematoma is a topic covered in the diseases and disorders to view the entire topic, please sign in or purchase a subscription nursing central is an awardwinning, complete mobile solution for nurses and students. Subdural hematoma a subdural hematoma sdh is a form of traumatic brain injury in which blood gathers between the dura and the arachnoid. Pathophysiology and nonsurgical treatment of chronic subdural. The sudden strike can destroy the blood vessels around the head and over the surface of the brain. Rapid spontaneously resolving acute subdural hematoma ncbi. An early theory about the formation of csdh was of a traumatic injury causing tearing of the bridging veins traversing from the brain to the draining duralvenous sinuses 1, 2. Jun 14, 2012 chronic subdural hematoma csdh is a common disease in the elderly, and the recurrence rate of csdh is reported to range from 2. Jul 26, 2018 a subdural hematoma sdh is a collection of blood below the inner layer of the dura but external to the brain and arachnoid membrane see the images below. Child abuse experts use diagnostic findings of subdural hematoma and retinal hemorrhages as nearpathognomonic findings to diagnose shaken baby syndrome.
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. Subdural hematoma is typically caused by a head injury. Subdural hematoma is the most common type of traumatic intracranial mass lesion. Acute subdural hematoma usually occurs after severe, highimpact injuries and is often associated with contusions of the adjacent areas of the brain. Scribd is the worlds largest social reading and publishing site. The usual mechanism that produces an acute subdural hematoma is a highspeed impact to the skull. A subdural hematoma is a collection of blood that forms on the surface of the brain. It is often cited as a major risk factor for csdh 4. Chronic subdural hematoma csdh is one of the most common neurosurgical conditions. The authors reported a case of refractory chronic subdural hematoma csdh in. Pdf chronic subdural hematoma csdh is one of the most common neurosurgical conditions.
Chronic subdural hematoma csdh is prevalent among elderly populations worldwide, and its mysterious pathogenesis has been discussed in the literature for decades. The risk factors for recurrence of chronic subdural hematoma. Chronic subdural hematomas are more common among people with alcoholism, older people, and people who take drugs that make blood less likely to clot anticoagulants or antiplatelets. Call 911 or your local emergency number, or go to an emergency room after a head injury. The issues remaining to be solved in regard to csdh include the initiating events. A subdural hematoma also may be an indication of child abuse, as evidenced by shaken baby syndrome. A subdural hematoma may happen after a severe head injury. It was first described by virchow, in 1857, as an internal hemorrhagic pachymeningitis. Pdf chronic subdural haematoma csdh is an encapsulated collection of blood and fluid on. This causes brain tissue to accelerate or decelerate relative to the fixed dural structures, tearing blood vessels. A venous hematoma may be acute occurring within a day of the injury and. A subdural hematoma is a collection of blood outside the brain. As early as 1826, bayle proposed that repeated bleeding episodes cause the ongoing expansion of csdhs. If the subdural hematoma is small subdural hematoma were published, neurologists and neurosurgeons have been well aware of this entity.
Chronic subdural haematoma csdh is an encapsulated collection of fluid, blood and blood degradation products layered between the arachnoid and dura mater coverings on the brains surface fig. A subdural hematoma occurs when a vein ruptures between your skull and your brains surface. Oct 10, 2016 037 pathophysiology of subdural hematoma 1. Acute hemispheric swelling associated with thin subdural. It can be lifethreatening and requires immediate attention. Zingale a1, chibbaro s, florio a, distefano g, porcaro s. There is lack of uniformity in the treatment of csdh amongst.
The common manifestations are altered mental state and focal neurological. If you sustain a major brain injury, this area can fill with blood and. Summary of the pathophysiological processes involved in the formation of a csdh. A hematoma occurs when blood leaks from a large blood vessel. The patient was symptomfree after the craniotomy procedure. No consensus about the pathophysiology of chronic sdh.
We analyzed 52 patients of acute subdural hematoma treated conservatively because of mild clinical symptoms andor thin subdural hematoma to elucidate the evolution from acute subdural hematomas to chronic subdural hematomas. A subdural hematoma sdh is a type of bleeding in which a collection of bloodusually associated with a traumatic brain injurygathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. At the same time they summarized the theories regarding the nature of this lesion and discussed its relation to the pachymeningitis haemorrhagica interna described by virchow. Subdural hematoma an overview sciencedirect topics. Chronic subdural haematoma is predominantly a disease of the elderly. In this lesson, you will learn about what causes a subdural hematoma as well as what symptoms are associated with it and how to treat it. The subdural hematoma sdh is a potentially devastating, yet curable extraaxial fluid collection classically associated with head trauma including rapid acceleration. Subdural hematomas are usually caused by severe head injuries. Presentations seen is dependent on the level of bleeding but general include siezures, apathy, weakness, lethargy, nausea, dizziness, behaviorual changes, confusion and severe headache.
Antagonists to specific neuropeptides of the trigeminal system modify brain swelling after trauma and should be further explored as potential therapy in brain trauma and subdural bleeding. Subgaleal hematoma is defined as blood collection within the loose areolar tissue of the scalp. Prostate dural metastasis presenting as chronic subdural hematoma. A guide for patients and families 4 chronic subdural hematomas are sometimes hard to diagnose because their symptoms can resemble so many different conditions. In 19 patients with chronic subdural hematoma, coagulation and fibrinolysis in venous blood taken at the time of surgery and in the hematoma contents aspirated from chronic subdural hematoma were. The prognosis and management of sdh will be discussed here. Ancillary signs of sulcal effacement and use to of manual windowing second set of ct images assist in del. Further expansion due to osmosis in some subdural bleeds, the arachnoid layer of the meninges is torn local. Pathophysiology and nonsurgical treatment of chronic subdural hematoma. Pathophysiology unlike in epidural hematomas, sdh usually results from the tears in veins. Subdural hematoma, bleeding into the space between the brain and its outermost protective covering, the dura. 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. The blood may press against the brain and damage the tissue. Chronic subdural hematoma in a case of untreated compensated congenital hydrocephalus has not been reported in english.
Computed tomography revealed the presence of an acute subdural hematoma with a midline shift beyond 1 cm. If your institution subscribes to this resource, and you dont have a myaccess profile, please contact your librarys reference desk for information on how to. Up to 40 percent of sdhs among the elderly were misdiagnosed at the time of hospital admission, often as dementia. Subacute subdural hematomas are the most difficult to identify especially when small, as the blood is isodense to the brain parenchyma. Pathophysiology of subdural hematomas clinical gate. In childhood, hematomas are a common complication of falls. Outcomesresolutions nearly 90% of the individuals regain their lost function and improve, if the hematoma is evacuated promptly. Management of chronic subdural hematoma in patients treated with anticoagulation. Undiagnosed or untreated individuals with chronic subdural hematoma may notice a slow decline of daytoday function. Subdural hematomas form between the dura and the arachnoid membranes epidural hematomas arise in the potential space between the dura and the skull. Dec 10, 2018 ishii n, yokosuka k, sekihara y, et al. Challenging the pathophysiologic connection between subdural. Chronic alcoholism causes propensity to experience trauma, hepatopathy, vascular fragility and brain atrophy. It typically results when a traumatic force applied to the head creates significant fastchanging velocities of the contents inside the skull.
A case of subdural hematoma associated with dural metastasis of lung cancer. There is lack of uniformity in the treatment of csdh amongst surgeons in terms of various treatment strategies. Chronic subdural hematoma csdh is one of the most frequent neurosurgical entities caused by head trauma. Acute subdural hematoma is the most common severe head injury and can be associated with severe neurologic disability and death in sports. In 1925 cushing and putnam 1 published reports of 11 cases of subdural hematoma in which the condition apparently arose as the result of trauma to the head. Subdural hematoma is defined as a collection of blood outside the brain below the dura mater. A chronic subdural hematoma may happen in older people after a minor head injury. The preferred surgical method continues to attract debate. Management of chronic subdural hematoma in patients treated.
A history of direct trauma to the head is absent in up to half the cases. This causes brain tissue to accelerate or decelerate relative to the fixed dural structures. Nursing diagnosis for subdural hematoma subdural hematoma. Subdural hematomas in infants with benign enlargement of the. Subdural hematoma in adults prognosis and management up to. Refractory chronic subdural hematoma supplied by contralateral. Review chronic subdural hematoma an uptodate concept. In the pediatric patient, trauma is the most common cause of subdural. Pathogenesis and pathophysiology of chronic subdural. Chronic subdural haematoma csdh is one of the most common neurological disorders, and is especially prevalent among elderly individuals. To access free multiple choice questions on this topic, click here. Intracranial hematomas injuries and poisoning merck. In this article, learn about the causes and symptoms of hematomas as well as the different types and when to see a doctor. Feb 25, 2015 acute subdural hematoma the manifestations appear during the first 3 days subacute subdural hematoma clinically manifests between 4 and 21 days chronic subdural hematoma the clinical manifestations appear after 21 days.
The expanding hemorrhage can increase the pressure inside the skull and compress the. What is the prognosis of chronic subdural hematoma. Aug 11, 2012 an understanding of this pathophysiology is crucial to the development of intervention and treatment of these conditions. Spinal injuries often occur with head injuries, so try to keep the persons neck still if you must move them before help arrives. Pathophysiology all sdh probably start out as acute subdurals. A subdural hematoma is caused by an injury to the head that tears blood vessels. Differential diagnosis subdural hematoma, subarachnoid hemorrhage, traumatic brain injury, transient ischemic attack seizure, intracranial abscess, brain tumor. A subdural hematoma forms because of an accumulation of blood under the. Always use safety equipment at work and play to reduce your risk for. Chronic subdural hematoma is a frequently encountered entity in neurosurgery in particular in elderly patients. From past to present to future author links open overlay panel dana c. There is lack of uniformity about the treatment strategies, such as the role of burr hole, twist drill, craniotomy, etc.
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