When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Subdural hematoma

Last reviewed: 5 Oct 2024
Last updated: 13 Jul 2023

Summary

Definition

History and exam

Key diagnostic factors

  • evidence of trauma
  • headache
  • nausea/vomiting
  • diminished eye response
  • diminished verbal response
  • diminished motor response
  • confusion
Full details

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
Full details

Risk factors

  • recent trauma
  • coagulopathy and anticoagulant use
  • advanced age (>65 years)
Full details

Diagnostic tests

1st tests to order

  • noncontrast CT scan
Full details

Tests to consider

  • MRI scan
  • plain skull x-ray
Full details

Treatment algorithm

ACUTE

acute hematoma

with ventriculoperitoneal shunt

ONGOING

chronic hematoma

Contributors

Authors

Christopher P. Robinson, DO, MS

Associate Professor of Neurology and Neurosurgery

Division of Neurocritical Care

Director

Shands Neuromedicine Intensive Care Unit

Program Director

NCC Fellowship

Neurology Clerkship Director

University of Florida College of Medicine

Florida

FL

Disclosures

CPR has received compensation for serving as an expert witness.

Acknowledgements

Dr Christopher P. Robinson would like to gratefully acknowledge Dr Andrew W. Grande, Dr Stephen J. Haines, Dr Praveen R. Baimeedi, Dr Jason S. Hauptma, and Dr Neil A. Martin, previous contributors to this topic.

Disclosures

AWG, 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
    More Differentials
  • Guidelines

    • Head injury: assessment and early management
    • ACR appropriateness criteria: head trauma
    More Guidelines
  • Calculators

    Glasgow Coma Scale

    Canadian CT Head Rule

    More Calculators
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer