Subdural hemorrhage

Hemorrhagic stroke is a result of bleeding into the brain and other spaces within the central nervous system and includes subarachnoid hemorrhage, intracerebral hemorrhage, and subdural hematomas. 

Suggested Alternatives for Differential Diagnosis Meningitis, basilar artery blood clots (thrombosis), cardioembolic stroke, cavernous sinus syndromes, cerebral venous blood clots (thrombosis), confusional states and acute memory disorders, epileptic and epileptiform encephalopathies, febrile seizures, haemophilus meningitis, intracranial hemorrhage, leptomeningeal carcinomatosis, subdural pus (empyema), or bruise (hematoma). 

Hemorrhagic strokes account for 12% of strokes and include subarachnoid hemorrhage, intracerebral hemorrhage, and subdural hematomas. Subarachnoid hemorrhage may result from trauma or rupture of an intracranial aneurysm or arteriovenous malformation. Intracerebral hemorrhage occurs when a ruptured blood vessel within the brain parenchyma causes formation of a hematoma. Subdural hematomas are most often caused by trauma. 

In a 50-year-old woman with uremia the platelet count fell from 149 x 109/1 to 45 x 109/1 after an abdominal hysterectomy with prophylactic desmopressin, and she developed a fatal subdural hemorrhage (65). 

Sun HL, Chien CC. Thrombocytopenia and subdural hemorrhage after desmopressin administration. Anesthesiology 1998 88(4) 1115-7. 

Subdural hemorrhage is usually traumatic rather than spontaneous, although the trauma can be very mild or forgotten in elderly patients and alcoholics. Spontaneous causes of subdural hemorrhage include ... 

Often no cause is found. Acute subdural hemorrhage appears hyperintense on CT brain scan whereas chronic subdural hematomas appear hypodense (Fig. 7.3). Hematomas of intermediate age, approximately four to six weeks, are often isodense to gray matter on CT and may be overlooked. 

Fig. 8.1. Brain CT scans showing acute (a) and chronic (b) subdural hemorrhage and illustrating that the changes seen in chronic subdural hemorrhage may be subtle.

Intracerebral extension of the hemorrhage occurs in at least a third of patients. Patients with a large hematoma and depressed consciousness might require immediate evacuation of the hematoma, preferably preceded by occlusion of the aneurysm (Niemann et al. 2003). Alternatively, extensive craniectomy can be employed to allow expansion of the brain, as for maUgnant middle cerebral artery infarction (Smith et al. 2002). Subdural hematomas are rare but life threatening and should be removed. 

Gore JM, Sloan M, Price TR, Randall AM, Bovill E, Collen D, Forman S, Knatterud GL, Sopko G, Terrin ML. Intracerebral hemorrhage, cerebral infarction, and subdural hematoma after acute myocardial infarction and thrombolytic therapy in the Thrombolysis in Myocardial Infarction Study. Thrombolysis in Myocardial Infarction, phase 11, pilot and clinical trial. Circulation 1991 83(2) 448-59. 

Sodium warfarin warfarin Spinai hematoma subdural hematoma vasculitis Uncontrolled bleeding hemorrhage... 

Spontaneous intracerebral hemorrhage occurred in a 72-year-old woman who had been taking GB 50 mg three times daily for 6 months (54). Bilateral subdural hematomas were discovered in a 33-year-old woman who had been taking 60 mg of GB twice daily for 2 year, acetaminophen, and occasionally an ergotamine/caffeine preparation (55). Bleeding time was elevated, but had normalized when checked approx 1 month after discontinuation of the product. 

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