Where I live, Subdural Hematomas (SDH) seem fairly common. A fall after tripping or a slip on ice and then the dreaded crescent of SDH on a Head-CT. The immediate decision point then is if a craniotomy is needed for surgical evacuation. The mnemonic T-SDH (as in Traumatic SDH ) helps me remember surgical indications for craniotomy. A neurosurgical consult MUST be sought with each & every case.
Mnemonic for craniotomy indications in Acute SDH: T-SDH
T – Thickness more than 10 (Ten) mm Or Thickness > 5 mm with Neuro signs OR
S – Shift (midline) > 5 mm OR
D – Dilated Pupils (one of both), Drowsiness Deteriorating (GCS worse > 2 pts) OR
H – Herniation signs (& ICD > 20 mm), Hydrocephalus complication
The above are general guidelines and I wanna stress that in each case, a neurosurgery opinion is still necessary.
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