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Subdural haematoma drainage in Tijuana — Dr. Carlos A. Noreña Osterroth
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Subdural haematoma drainage in Tijuana

Blood collected between the dura and the brain. In older adults it can appear weeks after a minor knock and be mistaken for dementia or a stroke.

Acute and chronic are two different diseases

An acute subdural haematoma appears hours after significant trauma, usually accompanies a brain contusion and is an immediate surgical emergency: the patient deteriorates fast and every hour counts. Evacuation is done through a wide craniotomy, because an acute clot is solid and will not come out of a small hole.

The chronic subdural haematoma is another story. It forms over weeks, often after a knock so minor the patient does not remember it, and mostly affects older people, those on anticoagulants and those with cerebral atrophy. The blood turns liquid and drains through one or two burr holes.

Symptoms that get mistaken for something else

Chronic subdural haematoma is a great imitator. Headache that comes and goes, unsteadiness, falls, confusion, drowsiness, personality change or one-sided weakness are frequently put down to dementia, to a stroke, or simply to age. A plain head CT settles it in minutes.

It is worth insisting on this because the outcomes differ so much: dementia does not reverse, and a chronic subdural haematoma drained in time usually returns the patient to their previous state. In an older adult who changed over weeks, the CT is not optional.

What the procedure involves

Plain head CTRapid diagnosis and classification of the haematoma as acute, subacute or chronic.
Burr hole evacuationOne or two holes and warm irrigation for the chronic haematoma, under local or general anaesthesia.
Craniotomy for the acute caseA solid acute clot demands wide exposure and control of the bleeding source.
Closed subdural drainageA drain is left for 24 to 48 hours: it reduces recurrence significantly.
Anticoagulation reviewCoordination with cardiology or internal medicine to stop and restart anticoagulants sensibly.

When it is indicated

  • Acute subdural haematoma with midline shift and neurological deterioration
  • Symptomatic chronic subdural haematoma in an older adult
  • Subdural hygroma with mass effect
  • Recurrence of a previously drained chronic subdural haematoma
  • Subdural haematoma in an anticoagulated patient who is deteriorating
  • Post-operative subdural collection with clinical consequences

Techniques and resources

  • Cranial burr hole
  • Closed drainage system
  • Head CT
  • Craniotome for acute cases
  • Local or general anaesthesia as indicated
  • Coagulation management

Frequently asked questions about subdural haematoma drainage

Yes, and that is exactly the classic picture. In older adults a chronic subdural haematoma can appear weeks after a minor knock and present as confusion, unsteady walking or one-sided weakness. Ask for a plain head CT: it is quick, inexpensive and it changes the outcome.

Burr hole drainage of a chronic haematoma is among the least invasive neurosurgical procedures: one or two small holes, sometimes under local anaesthesia, and a short hospital stay. An acute traumatic haematoma is a major, urgent craniotomy.

It can recur, particularly with marked cerebral atrophy or when anticoagulation is restarted. That is why a closed drain is left and CT follow-up is done. If it recurs, it is drained again.

Neurosurgical consultation

Bring your imaging and settle the question

One consultation with your MRI or CT in hand is worth more than ten internet searches. Book by phone or through the form and you will be told what is there, what it means and what your options are.

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