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Updated: Apr 29 2019

Subdural Hematoma

  • Snapshot
    • A 76-year-old man presents to the emergency department with increasing somnolence and lethargy. His symptoms developed on the day of admission. His symptoms are associated with a headache with mild nausea but no vomiting. He tripped over a carpet and hit his head on the floor. A head CT without contrast demonstrates a crescent-shaped hyperdensity that crosses the suture lines.
  • Introduction
    • Definition
      • venous bleeding in the potential space between the brain parenchyma
  • Epidemiology
    • Risk factors
      • cerebral atrophy, which can be seen in
        • aging
        • chronic alcohol use
        • previous tramautic brain injury
      • anti-thrombotic medication use
  • Pathogenesis
    • Head injury results in tearing of the bridging veins
  • Presentation
    • Symptoms/physical exam
      • acute subdural hematoma
        • coma
        • symptoms of increased intracranial pressure if the bleeding occurs in the posterior fossa
          • headache
          • nausea and vomiting
          • cranial nerve palsies
      • chronic subdural hematoma
        • headache
        • cognitive impairment
        • somnolence
  • Imaging
    • CT head without contrast
      • indication
        • imaging study of choice in the evaluation of a subdural hematoma
      • findings
        • crescent-shaped and concave hyperdensity that can extend across suture line
  • Differential
    • Epidural hematoma
      • differentiating factors
        • lens-shaped and biconvex hyperdensity that does not cross the suture lines
    • Subarachnoid hemorrhage
      • differentiating factors
        • thunderclap headache
        • hyperdensity in the subarachnoid space on CT head without contrast
  • Treatment
    • Operative
      • surgical evacuation
        • indication
          • treatment of choice in symptomatic (e.g., cranial nerve palsies, midline shift, and symptoms of increased intracranial pressure) subdural hematomas
  • Complications
    • Brain herniation
    • Seizures
    • Hydrocephalus
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