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Acute Subdural Hematoma

Acute Subdural Hematoma (SDH): Clinical Presentation Subdural Hematoma Authors: Cora Laidlaw Reviewers: Braxton Phillips Shahab Marzoughi Sina Marzoughi* * MD at time of publication Ischemia of cranial nerve tissue in brainstem Cranial nerve palsies ↓ Level of consciousness Generalized or focal seizures Uncal herniation Compression of oculomotor nerve (CN III) – responsible for eye movement (adduction, elevation, and depression) and parasympathetic tone Eyes fixed outwards and down with pupillary dilation ↑ Pressure compresses intracranial tissue Compression of brain structures Compression of arterial vasculature in brain ↓ Global perfusion to intracranial tissue Uncus (mediobasal aspect of temporal lobe) herniates into the infratentorial via the tentorial notch Cerebellar tonsils (part of posterior lobe of cerebellum) herniates through foramen magnum (opening in base of skull) Cerebellar tonsil herniation Tonsils compress brainstem Brainstem loses ability to control vital functions of life (such as respiration, heart rate, blood pressure) Coma or death Blood accumulation results in ↑ intracranial pressure (Bleeding within potential space between dura and arachnoid meningeal layers ) Compression of nociceptors in meninges and meningeal vasculature Headache Compression of medulla (contains emetic center) Stimulation of emetic centers Loss of function of primary sensory cortex (posterior to central sulcus) Contralateral hemisensory loss (including proprioception, fine touch, and two point discrimination) Loss of function of primary motor cortex (anterior to central sulcus) Contralateral hemiparesis (upper motor neuron) Ischemia and necrosis of brain parenchyma Cerebral disturbances altering neuronal networks Vomiting Nausea See Calgary Guide slide - Chronic Subdural Hematoma (SDH): Clinical Presentation Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Oct 4, 2024 on www.thecalgaryguide.com