Subdivision of subdural haematomas into acute and subacute forms serves no practical purpose. Chronic subdural haematoma however is best considered as a separate entity, differing both in presentation and management.
Chronic subdural haematoma - fluid may range from a faint yellow to a dark brown colour
A membrane grows out from the dura to envelop the haematoma
Chronic subdural haematomas occur predominantly in infancy and in the elderly. Trauma is the likely cause, although a history of this is not always obtained.
- Cerebral atrophy
- Low CSF pressure
(after a shunt or fistula) J
- Coagulation disorder
Breakdown of protein within the haematoma and a subsequent rise in osmotic pressure was originally believed to account for the gradual enlargement of the untreated subdural haematoma. Studies showing equality of osmotic pressures in blood and haematoma fluid cast doubt on this theory and recurrent bleeding into the cavity is now known to play an important role.
Clinical features tend to be non-specific.
- Deterioration in conscious level, occasionally with fluctuating course.
- Symptoms and signs of raised ICP.
- Focal signs occasionally occur, especially limb weakness. This may be ipsilateral to the side of the lesion, i.e. a false localising sign (see page 220).
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