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Introduction
Classification
Signs & Symptoms
Causes
Pathophysiology
Diagnosis
Treatment
Craniotomy
Complications
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A u
, also known as a
u (SDH), is a type of
hematoma, a form of traumatic brain injury in
which blood gathers within the outermost
meningeal layer, between the dura matter, which
adheres to the skull, and the arachnoid mater
enveloping the brain.
Usually results from tears in bridging veins that
cross the subdural space.
subdural hemorrhages may cause an
increase in intracranial pressure (ICP),
which can cause compression of and
damage to delicate brain tissue. Subdural
hematomas are often life-threatening
when acute, but chronic subdural
hematomas are usually not deadly if
treated.
In contrast, epidural hematomas are
usually caused by tears in arteries,
resulting in a buildup of blood between the
dura and the skull.
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pp
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Acute subdural
hematomas that are due
to trauma are the lethal
of all head injuries and
have a high mortality
rate if they are not
rapidly treated with
surgical decompression.
atiology of acute SDH
ÔHead trauma
ÔCoagulopathy or medical anticoagulation (eg,
warfarin [Coumadin], heparin, hemophilia,
liver disease, thrombocytopenia)
ÔNontraumatic intracranial hemorrhage due to
cerebral aneurysm, arteriovenous
malformation, or tumor (meningioma or dural
metastases)
ÔPostsurgical (craniotomy, CSF shunting)
ÔIntracranial hypotension (eg, after lumbar
puncture, lumbar CSF leak, lumboperitoneal
shunt, spinal epidural anesthesia
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Craniotomies are also named according to
their size and complexity.
Small dime-sized craniotomies are called
burr holes or keyhole craniotomies.
Sometimes stereotactic frames, image-
guided computer systems, or endoscopes
are used to precisely direct instruments
through these small holes.
Burr holes or keyhole craniotomies are used for
minimally invasive procedures to:
u
u
u
uu
include
increased intracranial pressure
brain edema
new or recurrent bleeding
infection and
seizure
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