Subdural hemorrhage

Causes:

Bleeding from a damaged cortical artery.
Bleeding from an underlying parenchymal injury.
Tearing of bridging veins from the cortex to one of the draining venous sinuses.

Blunt head trauma is the usual mechanism of injury but spontaneous SDH can arise as a consequence of clotting disorder, arteriovenous malformations/aneurysms or other conditions.

At-risk groups:

Infants: In the infant brain, SDHs are caused by tearing of the bridging veins in the subdural space and may result in significant brain injury.
The elderly: Cerebral atrophy causing tension on the veins, which may also be weaker and more susceptible to injury as a consequence of age. (Chronic subdural haematoma is more common in this age group)
Alcoholics: higher risk of thrombocytopenia, prolonged bleeding times and blunt head trauma. Alcoholism also causes cerebral atrophy which can put tension on the bridging veins
People on anticoagulation treatment: (aspirin or warfarin)

Presentation of chronic subdural haemorrhage:

Usually presents about 2-3 weeks following the provoking trauma.
Symptoms tend to be gradually progressive.
There is often a history of anorexia, nausea and/or vomiting.
Gradually evolving neurological deficit such as focal limb weakness, speech difficulties, increasing drowsiness/confusion or personality changes.
accompanying and progressive headache
papilloedema, bradycardia and hypertension associated with raised intracranial pressure.
reduced consciousness level

	Creado por bessimajamal hace casi 10 años

Apunte sobre Neurology, creado por bessimajamal el 13/06/2014.