Subdural hematoma

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 traveling to the dural venous sinuses.

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

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

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

Control of elevated 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 hematoma, neurologic deficit, reaccumulation of subdural hematoma, coma, and death.

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