Subdural hematoma

Last reviewed: 5 Sep 2022
Last updated: 11 Mar 2020

Summary

Definition

History and exam

Key diagnostic factors

  • evidence of trauma
  • headache
  • nausea/vomiting
  • diminished eye response
  • diminished verbal response
  • diminished motor response
  • confusion
More key diagnostic factors

Other diagnostic factors

  • loss of consciousness/decreased alertness
  • seizure
  • loss of bowel and bladder continence
  • localized weakness
  • sensory changes
  • cognition changes
  • speech or vision changes
  • otorrhea
  • rhinorrhea
Other diagnostic factors

Risk factors

  • recent trauma
  • coagulopathy and anticoagulant use
  • advanced age (>65 years)
More risk factors

Diagnostic investigations

1st investigations to order

  • noncontrast CT scan
More 1st investigations to order

Investigations to consider

  • MRI scan
  • plain skull x-ray
More investigations to consider

Treatment algorithm

ACUTE

acute hematoma

with ventriculoperitoneal shunt

ONGOING

chronic hematoma

Contributors

Authors

Andrew W. Grande, MD

Assistant Professor of Neurosurgery

University of Minnesota

Minneapolis

MN

Disclosures

AWG declares that he has no competing interests.

Acknowledgements

Dr Andrew W. Grande would like to gratefully acknowledge Dr Stephen J. Haines, Dr Praveen R. Baimeedi, Dr Jason S. Hauptma, and Dr Neil A. Martin, previous contributors to this topic. SJH, PRB, JSH, and NAM declare that they have no competing interests.

Peer reviewers

Nathan J. Ranalli, MD

Resident

Department of Neurosurgery

University of Pennsylvania School of Medicine

Philadelphia

PA

Disclosures

NJR declares that he has no competing interests.

Marek Ma, MD

Instructor

Emergency Medicine

Department of Emergency Medicine Administrative Offices

University of Pennsylvania

Philadelphia

PA

Disclosures

MM declares that he has no competing interests.

  • Subdural hematoma images
  • Differentials

    • Epidural hematoma
    • Intracerebral hematoma
    • Diffuse axonal injury
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  • Guidelines

    • Head injury: assessment and early management
    • Guidelines for the management of severe traumatic brain injury, 4th edition
    More Guidelines
  • Calculators

    Glasgow Coma Scale

    Canadian CT Head Rule

    More Calculators
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