Subdural haematoma

Extra-axial blood collection between the dura and arachnoid layers surrounding the brain. May be due to arterial or venous bleeding, although most often occurs as a result of the disruption of bridging veins travelling to the dural venous sinuses.

Variable disease course, depending on size of haematoma, age of the patient, presenting neurological signs/symptoms, presence of underlying coagulopathy or neoplasm, and associated injuries.

One week of antiepileptic (e.g., phenytoin, phenobarbital, levetiracetam) therapy should be considered in all cases of acute and acute-on-chronic subdural haematoma.

Aggressive reversal of coagulopathy should be accomplished in all patients with subdural haematoma who are taking anticoagulants.

Surgical therapy is usually indicated for acute or chronic subdural haematomas that are expansile or causing neurological deficit. Observation may be employed for small, stable subdural haematomas that are not causing neurological compromise.

Control of raised intracranial pressure using head-of-bed elevation, analgesics and narcotics, intubation with hyperventilation, osmotic diuretics (mannitol) and loop diuretics, hypertonic saline, external ventricular drainage, barbiturates, mild hypothermia, or decompression hemicraniectomy may be required.

Treatment complications include stroke, seizures, vascular injury to cortical veins and arteries or dural sinuses adjacent to the haematoma, neurological deficit, re-accumulation of subdural haematoma, coma, and death.

Subdural haematoma is a collection of blood between the dural and arachnoid coverings of the brain. As the volume of the haematoma increases, the intracranial pressure may rise and cause herniation. While the presence of subdural haematoma can be inferred by neurological decline and mechanism of traumatic injury, the diagnosis is typically made radiographically.