Summary
Definition
History and exam
Key diagnostic factors
- evidence of trauma
- headache
- nausea/vomiting
- diminished eye response
- diminished verbal response
- diminished motor response
- confusion
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
Risk factors
- recent trauma
- coagulopathy and anticoagulant use
- advanced age (>65 years)
Diagnostic investigations
1st investigations to order
- noncontrast CT scan
Investigations to consider
- MRI scan
- plain skull x-ray
Treatment algorithm
acute hematoma
with ventriculoperitoneal shunt
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.
Differentials
- Epidural hematoma
- Intracerebral hematoma
- Diffuse axonal injury
More DifferentialsGuidelines
- Head injury: assessment and early management
- Guidelines for the management of severe traumatic brain injury, 4th edition
More GuidelinesCalculators
Glasgow Coma Scale
Canadian CT Head Rule
More CalculatorsLog in or subscribe to access all of BMJ Best Practice
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