Transcript SYB 2 - MyPACS.net

SYB 2
Marni Scheiner
MS IV
What kind of image is this, and what do you see?
Subdural Hematoma

Typically following head trauma
(falls/assaults)
 May follow minor trauma
 Acceleration/Deceleration
Injury

Rupture of bridging veins

Accumulation of blood between
the dura and arachnoid
membranes

Common in elderly, babies
(shaken baby syndrome) and
alcoholics.
http://www.sbsdefense.com/images/Meninges1.jpg
Subdural Hematoma

Signs and symptoms












As quick as 24 hrs, but may appear as much as 2 weeks later.
Vein hemorrhage= lower pressure than arteries (in epidural
hematomas)=bleed more slowly
H/x of recent head injury/fall
LOC/ change in mental status/delerium/dementia
Seizure
Headache
N/V
Personality changes
Slurred speech, inability to speak
Ataxia
Blurred vision
If large enough, may cause signs of increased ICP or
damage to part of the brain will be present.
Subdural Hematoma

3 subtypes: (depend on speed of onset)
 Acute
 due to trauma
 Most severe if associated with cerebral contusion
 most lethal of all head injuries -- high mortality rate (20%-50%)if
they are not rapidly treated with surgical decompression.
 Subacute


3-7 days after acute injury
Chronic

2-3 weeks after acute injury

often after minor head trauma (50% pts have no identifiable cause)

Slow bleed, repeated minor bleeds, and usually self limited
Small subdural hematomas (<1cm wide) have much better
outcomes than acute subdural bleeds

Radiographic Signs of Subdural
Hematoma

MRI vs CT:
 MRI better for size and effect on brain.
 Non-contrast CT is primary means of making a diagnosis and
eval for treatment.

Non-contrast Head CT:
 General:
 Crosses the suture lines, but not the dural reflections (DOES
NOT CROSS THE MIDLINE)
 Moderate/large size: cause midline shift.
 Look for edema, may indicate future herniation
 Usually no skull fracture
Radiographic- Subdural
Noncontrast Head CT:



Acute:
 hyperdense, crescentic shaped
 Most common area: parietal region, and above the tentorium
cerebelli
Sub-acute:
 Isodense (with respect to brain)
 More difficult to see with non-contrast. Contrast-enhanced CT
or MRI recommended for imaging 48-72 hrs after injury.
Chronic:
 Hypodense, easy to see on non-contrast head CT scan.
Pathophysiology

Collected bood--> draw in water osmotically-->brain
expansion--> compression of brain tissue--> new
bleeds/tearing other blood vessels.

Sometimes, arachnoid layer is torn--> CSF and blood
both expand in the intracranial space--> increasing ICP.

If self-limited: The body gradually reabsorbs the clot and
replaces it with granulation tissue.
Treatment

Depends on hematoma size and rate of growth.

Small subdural hematomas:


Large or symptomatic hematomas:


careful monitoring until the body heals itself
Craniotomy (open skull, remove blood clot, and
control site of bleeding)
Post-op complications:

increased ICP, brain edema, bleeding, infection, and
seizure.