✔️10–20% of all patients with craniocerebral trauma.
✔️Blood between the dura mater and arachnoid
✔️Usually venous bleeding
✔️A blow to the head puts tension on the cerebral veins, and they typically tear at their attachment to the dural sinuses.
✔️Acute subdural hematomas are an absolute emergency indication
✔️In 95 % of all cases, the lesion is supratentorial (especially frontoparietal)
✔️Bilateral hematoma is present in 15% of all cases.
✔️Imaging Modality of choice: CT
✔️CT findings (Acute subdural hematoma):
〰Hyperdense crescent-shaped hemorrhage(early acute components can appear hypodense)
〰Not bounded by sutures
〰subdural hematoma is concave
〰Significant mass effect: midline displacement
〰Obstructed flow of CSF, blockage of the interventricular foramen of Monro
〰Reduced demarcation between gray and white matter
〰Cisterna ambiens obliterated
〰Usually there is no visible fracture
✔️Postoperative contralateral rebleeding may occur in response to removal of the tamponade.
✔️Chronic subdural hematoma: Isodense or hypodense collection of blood in a crescent along the brain
✔️With isointense hematomas, the midline displacement is often the only detectable sign of a hematoma
✔️The contrast enhancement of the cerebral vessels after IV administration of contrast agent aids in differentiating the hematoma from brain tissue
✔️Significant mass effect
✔️MRI is not indicated in an acute subdural hematoma
✔️In a chronic subdural hematoma, MRI can be used to estimate the age of the lesion
✔️Anisocoria or suddenly fixed pupils are an alarm signal but a late sign . Patients are often intubated.
✔️Prognosis is usually poor if concomitant administration of drugs such as acetylsalicylic acid and clopidogrel has been there
✔️In the CT, clinician should look for :
Extent • Midline displacement • Size of basal cisterns • Obstructed flow of CSF.
✔️Be careful to avoid missing of bilateral isodense chronic subdural hematomas.
#sdh ,#neurosurgery ,#anesthesiology , #BrainImaging , #CTbrain
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