Subtle sudural haemorrhage and frontal contusion in trauma patient

Case contributed by Dr Dayu Gai

Presentation

This 80 year old female was involved in a high speed motor vehicle accident. A CT brain was performed.

Patient Data

Age: 80
Gender: Female

Conclusion:

  • There is a trace right subdural haemorrhage over the lateral convexity, measuring 3mm in depth. There is a linear hyperdensity in the right posterior frontal region may represent a small amount of subarachnoid blood or contusion.

There is a trace right subdural haemorrhage over the lateral convexity, measuring 3mm in depth. There is a linear hyperdensity in the right posterior frontal region may represent a small amount of subarachnoid blood or contusion.

Case Discussion

Subdural haemorrhage is a collection of blood in between the dura mater and the arachnoid mater of the brain. In young adults, subdural haemorrhage is typically caused by traumatic head injury associated with motor vehicle accidents. It is said to have an incidence of 12-29% of patients presenting with severe traumatic brain injury1

Patients with subdural haemorrhage can often present with neurological signs, such as a decreased conscious state or pupillary changes.

Treatment of subdural haematomas depends on the chronicity (acute vs chronic) as well as the degree of mass effect that is being produced. Surgical intervention in acute subdural haematoma can be dictated by the following guidelines2:

  1. SDH thickness greater than 10mm
  2. Midline shift greater than 5mm
  3. Neurological changes - GCS drop by 2 or more points; assymetric pupils; intracranial pressure > 20mm Hg

In this case, this small subdural haemorrhage did not have any midline shift, and was not associated with any neuorological changes. The haemorrhage was managed conservatively.

Case contributed by A/Prof. Pramit Phal.

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Case Information

rID: 32054
Case created: 11th Nov 2014
Last edited: 5th Jul 2016
Inclusion in quiz mode: Included

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