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Subdural Hematoma
Aka: 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
- Convulsions
- 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 Bloody or xanthochromic fluid
- Diagnostic Testing: EEG
- Localized disturbance
- Management
- Surgical decompression
- Emergency surgical decompression if acute Subdural Hematoma
- 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 Hematomas
- References
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21