Podcast #166: Subdural Hematoma

00c86def-a234-422b-a345-2431643f87c8Run Time: 6 minutes

Author: Peter Bakes M.D.

Educational Pearls:

  • There are 3 layers of tissue between skull and brain – the dura which is adhered to the skull, the arachnoid, and the pia which is adhered to the brain.
  • There are bridging veins between the pia-arachnoid space, when these rupture the blood accumulates under the dura between the arachnoid space, usually in the temporal lobe, but can occur anywhere, resulting in a subdural hematoma.
  • Acute SDH: manifests as a hyperintense on imaging in the first 2 days, and manifests as an isodense from 2-14 days.
  • Chronic SDH: greater than 14 days manifest as hypodense.
  • Any SDH greater than 5mm is considered for surgical intervention if the patient is symptomatic, and any SDH greater than 10mm or with significant midline shift, regardless of symptoms are surgically treated.
  • A craniotomy (remove skull and put it back) is performed to evacuate the hematoma.
  • A craniectomy (remove skull and don’t put it back) is performed if the patient has underlying tissue damage and expected interval swelling.
  • Chronic SDH are only treated with trephination (poke a hole in it) if the patient is significantly symptomatic, in case there is a future need to perform a craniotomy.

Link to Podcast: http://medicalminute.madewithopinion.com/subdural-hematoma/

References: http://neurosurgery.ucla.edu/acute-subdural-hematomas

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