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 tests
1st tests to order
- noncontrast CT scan
Tests to consider
- MRI scan
- plain skull x-ray
Treatment algorithm
acute hematoma
with ventriculoperitoneal shunt
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.
Differentials
- Epidural hematoma
- Intracerebral hematoma
- Diffuse axonal injury
More DifferentialsGuidelines
- Head injury: assessment and early management
- ACR appropriateness criteria: head trauma
More GuidelinesCalculators
Glasgow Coma Scale
Canadian CT Head Rule
More Calculators- Log in or subscribe to access all of BMJ Best Practice
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