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 🌙 shows up on Head-CT. The immediate decision-making 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 (& ICP > 20 mm), Hydrocephalus complication
There are more nuances to craniotomy decision-making than these listed indications, hence in each case, a neurosurgery opinion is still necessary!
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