Chronic Subdural Haematoma

Diagnosis

CT Scan appearances depend on the time between the injury and the scan.

With injuries 1-3 weeks old, the subdural haematoma may be isodense with brain tissue. In this instance, i.v contrast enhancement may delineate the cortical margin. Beyond 3 weeks subdural haematomas appear as a low density lesion.

If CT scan shows midline shift without any obvious extra- or intracerebral lesion, look at the shape of the ventricles.

Separation of the frontal and occipital horns suggests an intrinsic lesion, e.g. encephalitis — rather than a surface collection

Injury > 3 weeks old: low density lesion seen over hemisphere convexity.

Isodense lesion causing midline shift. Note the shape of the ventricles.

Injury > 3 weeks old: low density lesion seen over hemisphere convexity.

Extracerebral collection, i.e. chronic subdural haematoma, causes approximation of frontal and occipital horns

Isodense lesion causing midline shift. Note the shape of the ventricles.

Extracerebral collection, i.e. chronic subdural haematoma, causes approximation of frontal and occipital horns

Management

Management

Adult

The haematoma is evacuated through two or three burr holes and the cavity is irrigated with saline. Drains may be left in the subdural space and nursing in the head-down position may help prevent recollection.

Craniotomy with excision of the membrane is seldom required.

In patients who have no depressed conscious level, conservative treatment with steroids over several weeks may result in resolution.

Infants

The haematoma is evacuated by repeated needle aspiration through the anterior fontanelle. Persistent subdural collections require a subdural peritoneal shunt. As in adults, craniotomy is seldom necessary.

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