Subdural hemorrhage

Epidemiology

• Occurs in 5% of closed head injuries
  • But up to 27% of severe head injuries

Etiology

• Rupture of bridging veins traversing subdural space
• Acceleration contributes but not impact
• Can occur without apparent trauma in the elderly or due to anticoagulation and a minor injury
• Often shows underlying parenchymal damage
• Chronic subdural bleeds are common in the elderly or in patients with shunts (related to over-draining)

Clinical Presentation

• Acute
  • May be minor trauma that patient doesn't even remember
  • More common with falls than motor vehicle collisions
• Chronic
  • Elderly patients
  • Patients with shunts that are over-draining

Investigations

• CT head shows crescent-shaped bleed
  • Midline shift >1 cm is very worrying and requires urgent neurosurgery