b9781416049197x50014-b9781416049197500396-main
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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.
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Chapter 37: Subdural hematoma
Chapter 37 Subdural hematoma
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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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