What are the implications of a subdural hematoma due to a burst lobe (cerebral lobe) injury?

From the Guidelines

A burst lobe injury with subdural hematoma is a life-threatening condition that requires immediate neurosurgical intervention to prevent further neurological deterioration and improve outcomes. The patient should be rushed to the nearest trauma center or hospital with neurosurgical capabilities. Initial management includes:

• Stabilize airway, breathing, and circulation
• Elevate head of bed to 30 degrees
• Administer mannitol 1g/kg IV bolus to reduce intracranial pressure
• Give levetiracetam 1000 mg IV for seizure prophylaxis
• Obtain urgent CT scan of the head Definitive treatment typically involves emergency craniotomy to evacuate the hematoma and control bleeding, as recommended by the American Heart Association/American Stroke Association guideline 1. The neurosurgeon may also perform a decompressive craniectomy if there is significant brain swelling. Post-operative care includes:

• Close neurological monitoring in ICU
• Intracranial pressure monitoring, as suggested by the study published in Anaesthesia 1
• Continued seizure prophylaxis
• Gradual normalization of blood pressure
• Prevention of secondary brain injury (maintain normal oxygenation, avoid fever, control blood glucose) The implications of a subdural hematoma due to a burst lobe injury are severe and can lead to increased intracranial pressure, potential herniation, and brainstem compression, as highlighted in the study published in Stroke 1. Rapid intervention is crucial to prevent further neurological deterioration and improve outcomes. The study published in Anaesthesia 1 also emphasizes the importance of individualizing the objectives of intracranial pressure and cerebral perfusion pressure in the management of severe traumatic brain injury.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Implications of Subdural Hematoma due to Burst Lobe Injury

The implications of a subdural hematoma due to a burst lobe (cerebral lobe) injury can be severe and potentially life-threatening. Some of the key implications include:

• Rapidly deteriorating neurological function, which can lead to irreversible brainstem injury if left untreated 2
• Increased intracranial pressure, which can cause further brain damage and compromise cerebral blood flow 3
• Risk of co-existing lesions, such as traumatic brain injury, and complications like coagulopathy and delayed hematomas 3
• High mortality rate, particularly in elderly patients with prehospital anticoagulant and antiplatelets 3

Surgical Management

Surgical management of subdural hematomas is often necessary to evacuate the hematoma and reverse critically elevated intracranial pressure. Some of the surgical options include:

• Craniotomy, which involves opening a portion of the skull to access the hematoma 4, 3
• Decompressive craniectomy, which involves removing a portion of the skull to allow the brain to expand and relieve pressure 3
• Burr-hole drainage, which involves creating a small hole in the skull to drain the hematoma 4, 5
• Subdural evacuating port system (SEPS), which is a minimally invasive technique that can be performed at the bedside 2

Palliative Care

In some cases, palliative care may be considered, particularly for patients with poor baseline function or those who are elderly. A cranial burr hole can be a potential palliative care treatment to relieve intracranial pressure and improve quality of life 5. Interdisciplinary discussions of minimally invasive neurosurgical interventions can help determine the best course of treatment for each patient.