CV
Subdural Hematoma
search
Subdural Hematoma
, Subdural Hemorrhage
See Also
Head Injury
Management of Severe Head Injury
Increased Intracranial Pressure in Closed Head Injury
Brainstem Herniation
Neurovascular Anatomy
Epidural Hematoma
Subarachnoid Hemorrhage
Intracerebral Hemorrhage
Risk Factors
Elderly
Alcoholism
Anticoagulation
(e.g.
Warfarin
)
Pathophysiology
Cranial
Trauma
results in Subdural Hemorrhage
Tear of bridging veins between dura and surface of the brain
Six times more common than
Epidural Hematoma
Precautions
Acute Subdural Hematoma
Acute Subdural Hematomas are vastly different than chronic subdurals
Acute Subdural Hematoma has a 60-80% mortality rate
Requires rapid assessment and management (surgical decompression)
Causes
Acute Subdural Hematoma
Severe Closed Head Injury
Rapid Deceleration Injury
Associated Conditions
Acute Subdural Hematoma
Comorbid
Brain Contusion
Symptoms
Acute (Rapid progression of symptoms)
Headache
Irritability
Chronic (Insidious symptom progression)
Intermittent
Headache
Variable levels of
Decreased Level of Consciousness
Signs
Acute (<24 hours)
Fluctuating levels of consciousness
Dilated pupils
Hemiplegia
Hyperreflexia
Babinski's Sign
Convulsion
s
Subacute (24 hours to 2 weeks)
Chronic (>2 weeks)
Progressively impaired intellect
Agitation
Impulsive behavior
Hemiparesis
Stupor
Variable
Level of Consciousness
Imaging
CT Head
Subdural Hematoma appears as crescent-shaped
Hematoma
As this is below the dura, the Subdural Hematoma follows the surface of the brain
Gyri are absent in region of Subdural Hematoma
Helps identify subacute Subdural Hematoma which is isodense and more difficult to distinguish
Appearance varies based on timing
Acute: White blood collection
Subacute: Isodense blood collection (may be subtle)
Chronic: Dark blood collection
Labs
Cerebrospinal fluid
Increased
CSF Opening Pressure
CSF Protein
increased
CSF Blood
y or xanthochromic fluid
Diagnostic Testing
EEG
Localized disturbance
Management
Admit all patients with chronic or acute Subdural Hematoma (SDH)
Anticoagulation
and antiplatelet agent use predisposes to subdural expansion
Manage systolic
Blood Pressure
, targets per neurosurgery, but typically <180 mmHg
Surgical decompression
Emergency surgical decompression if acute Subdural Hematoma with signs of
Hernia
tion
See
Skull Trephination
Over age 65 years old, are unlikely to need surgical intervention if
Midline shift <=1 mm
Width <= 10 mm
Evans (2015) Injury 46(91): 76-9 [PubMed]
Prognosis
Worse prognosis than
Epidural Hematoma
(given decompression)
Subdural Hematomas are associated with greater brain parenchymal injury than
Epidural Hematoma
s
References
Dreis (2020) Crit Dec Emerg Med 34(7):3-21
Marcolini and Swaminathan in Swadron (2023) EM:Rap 23(5): 13-14
Type your search phrase here