Highlights & Basics
- Subdural hematoma (SDH) has a variable disease course, depending on size of hematoma, age of the patient, presenting neurologic signs/symptoms, presence of underlying coagulopathy or neoplasm, and associated injuries.
- One week of prophylactic antiepileptic therapy (e.g., phenytoin, levetiracetam) should be considered in all cases of acute and acute-on-chronic SDH, according to the Brain Trauma Foundation guidelines.
- Aggressive reversal of coagulopathy should be accomplished in most patients with SDH who are taking anticoagulants.
- Surgical therapy is usually indicated for acute or chronic SDHs that are expansile or causing neurologic deficit. Observation may be employed for small, stable SDHs that are not causing neurologic compromise.
- Control of elevated intracranial pressure using head-of-bed elevation, analgesics, intubation with anesthetics and sedation, hyperosmolar treatment, barbiturates, or decompressive hemicraniectomy may be required.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Coronal CT scan of the brain of an 80-year-old man with a gait disorder and a progressive cognitive impairment dating back about 6 months, showing a bilateral chronic subdural hematoma up to the convexity
Coronal CT scans of the brain of an 80-year-old man with a gait disorder and a progressive cognitive impairment dating back about 6 months, showing a bilateral chronic subdural hematoma up to the convexity
Citations
Expert Panel on Neurological Imaging; Shih RY, Burns J, Ajam AA, et al. ACR Appropriateness Criteria® head trauma: 2021 update. J Am Coll Radiol. 2021 May;18(5S):S13-36.[Abstract][Full Text]
Brain Trauma Foundation. Guidelines for the management of severe traumatic brain injury, fourth edition. Sep 2020 [internet publication].[Full Text]
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