DEFINITIONA subdural hematoma is bleeding into the subdural
space caused by rupture of bridging veins between the brain and
ve-nous sinuses.PHYSICAL FINDINGS AND CLINICAL PRESENTATION Vague
headache, often worse in morning than evening Some apathy,
confusion, and clouding of consciousness are
common, although frank coma may complicate late cases. Chronic
subdural hematomas may cause a dementia-like clinical picture.
Neurologic symptoms may be transient, simulating TIA. Almost any
sign of cortical dysfunction may occur, includ-
ing hemiparesis, sensory de cits, or language abnormalities,
depending on which part of the cortex is compressed by the
hematoma.
New-onset seizures should raise the index of suspicion.CAUSE
Traumatic rupture of cortical bridging veins, especially
where stretched by underlying cerebral atrophyDIFFERENTIAL
DIAGNOSIS
Epidural hematoma Subarachnoid hemorrhage (see Fig. 358) Mass
lesion (e.g., tumor) (see Fig. 381) Ischemic stroke (see Fig. 355)
Intraparenchymal hemorrhage (see Fig. 353)
WORKUP CT scan is sensitive for diagnosis and should be
performed
in a timely fashion (Fig. 371). Hematocrit, platelet count, PTT,
and PT/INR should be rou-
tinely checked.TREATMENT Small subdural hematomas may be left
untreated and the
patient observed but, if there is an underlying cause, such as
anticoagulation, this should be rapidly corrected to prevent
further accumulation of blood.
Neurosurgical drainage of blood from subdural space via a burr
hole is the de nitive procedure, although it is common for the
hematoma to reaccumulate.
There is an increased risk of seizures, which should be treated
appropriately if they arise.
183
Chapter 37: Subdural hematoma
Chapter 37 Subdural hematoma
37
Fig 371CT scan of acute subdural hematoma, 85-year-old woman.
The het-erogeneous density of irregular shape occupies extra-axial
space over-lying the left cerebral convexity. There is moderate
mass effect exhib-ited by effacement of convexity sulci and midline
shift with subfascial herniation. This required surgical
decompression.(From Grainger RG, Allison DJ, Adam A, Dixon AK
[eds]: Grainger and Allisons Diagnostic Radiology: A Textbook of
Medical Imaging, 4th ed. London. Harcourt, 2001.)
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