Subdural haemorrhage

Subdural haemorrhages (SDH) result from rupture of cortical bridging veins. These connect the venous system of the brain to the large intradural venous sinuses and lie relatively unprotected in the subdural space.

Acute subdural haemorrhage is usually associated with severe brain injury following trauma. It can occur at any age.

Chronic subdural haemorrhage may be traumatic or may arise spontaneously. It is most common in infants and the elderly. Blood slowly accumulates in the subdural space, usually overlying the frontal and parietal lobes. It becomes encysted between an outer wall of highly vascularised, granulation tissue adherent to the dura, and a thinner, inner wall of fibrous tissue. It is frequently bilateral

Dexamethasone in adults with symptomatic chronic subdural hematoma:

• a 2-week course of oral dexamethasone was associated with fewer favourable outcomes and more serious adverse reactions than placebo in older patients (average age 74 years) with chronic subdural haematoma (1)

Acute SDH is associated with mortality rates as high as 50% to 90% in patients who present with Glasgow Coma Scale (GCS) scores of 8 or less. Among all patients with acute SDH, fewer than 25% ultimately achieve a full recovery without any major neurological deficit. (2)

Reference:

1. Hutchinson PJ et al. Trial of Dexamethasone for Chronic Subdural Hematoma N Engl J Med 2020; 383:2616-2627 DOI: 10.1056/NEJMoa2020473
2. Huang KT, Bi WL, Abd-El-Barr M, et al. The neurocritical and neurosurgical care of subdural hematomas. Neurocrit Care. 2016 Apr;24(2):294-307.