Exam Cram

• Moa: venous slow bleeding within the meninges, below the dura

• Presentation: low impact fall in elderly or alcoholic with headache, lucent period followed by dropped GCS

• Diagnosis: CT-Head, crescent shaped haematoma

• Management: w/h anticoagulants and discuss with neurosurgery ?operation (rarely done)

Outline

Background

• Vein damaged: bridging vein. 

Assessment

History

• Old, frail, alcoholic

• Fall and lucid period

• Re-declined: worsening confusion or drowsiness

Examination

• Reduced GCS

• Focal neurology

• Raised ICP- papiloedema

Investigations

• CT-Head: crescent shaped haematoma (white)

Diagnosis & Classification

Diagnosis: imaging finding on CT or MRI

Differentials: Extra-dural haematoma- high impact in adult/ child

Management

Acute

1. Withhold and reverse any anticoagulants or VTE prophylaxis

2. Discuss with neurosurgery ?operative management

3. Escalation status & seizure management if deteriorates (usually levetiracetam)

Med Reg Notes

Neurosurgical Factors

• Pre-morbid baseline

• Current neurological impairment

• Age of lesion and trajectory of symptoms

In my experience, it is rare for neurosurgery to surgically manage SDH. 

References and Resources

Written in 2024