medical notes

Apr 17th, 2015
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SUB-DURAL HAEMATOMAA subdural hematoma (SDH) is classified by the amount of time that has elapsed from the inciting event, if known, to the diagnosis. When the inciting event is unknown, the appearance of the hematoma on CT scan or MRI can help date the hematoma.1. Acute SDHs are less than 72 hours old and are hyperdense compared to the brain on CT scan.2. Subacute SDHs are 3-20 days old and are isodense or hypodense compared to the brain. 3. Chronic SDHs are older than 20 days and are hypodense compared to the brain. An acute SDH commonly is associated with extensive primary brain injury. This diffuse parenchymal injury correlates strongly with the outcome of the patientThe presence of brain atrophy or loss of brain tissue due to any cause, such as old age, alcoholism, or stroke, provides a potential space between the dura and the brain surface for a SDH to formPathophysiology: Acute subdural hematoma The usual mechanism to produce an acute SDH is high-speed impact to the skull. This causes brain tissue to accelerate relative to a fixed dural structure, which, in turn, tears bridging veins. This mechanism also leads to associated contusions, brain edema, and diffuse axonal injury. The ruptured blood vessel often is a vein connecting the cortical surface to the dural sinuses. Alternatively, a cortical vessel can be damaged by direct laceration. An acute SDH due to a ruptured cortical artery may be associated with only minor head injury, and no cerebral contusions

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