SDH
As the name suggests itself, there is collection of blood beneath the dural layer but ouside the aracanoid layer of brain. Most common cause is rupture of bridging veins which travel from surface of brain till the venous sinuses which are densely adherent to inner surface of skull bone, usually in midline.
Causes of Subdural Hematoma
- Head injury
- Trivial trauma in old age, with atrophied brain
- Hypertension
- Dural surface vessels malformation–fragility
Risks:
It leads to raised intracranial pressure and imposes a risk to life if unattended.
Treatment:
If it is thin 1-4 mmthen conservatively managable using mannitol, lasix, Anticonvulsants.
If thickness is moderate upto 5-7 mm then patient is drowsy and may need ventilator support, can still be managed conservatively.
Surgical Aspects:
It varies if it is acute or chronic
if acute and it is causing mass effect/ midline shift of >5 mm, needs surgery–Decompression craniotomy.
If chronic or subacute then need simple hole surgery named as BURR HOLE Surgery
Prognosis:
Acute–Guarded, risk of life is 10-100% depends upon the time lag b/w the injury/detection and surgery. So urgent surgery is always better.
Chronic–very good, with chances of recurrence and need drainage .The photograph on the left is of a patient treated by Dr vikas Kathuria , burr holes were done only, he is walking and fully normal.
