II. Risk Factors

III. Pathophysiology

  1. Cranial Trauma results in Subdural Hemorrhage
  2. Tear of veins between dura and surface of the brain
  3. Six times more common than Epidural Hematoma

IV. Precautions: Acute Subdural Hematoma

  1. Acute Subdural Hematomas are vastly different than chronic subdurals
  2. Acute Subdural Hematoma has a 60-80% mortality rate
  3. Requires rapid assessment and management (surgical decompression)

V. Causes: Acute Subdural Hematoma

  1. Severe Closed Head Injury
  2. Rapid Deceleration Injury

VI. Associated Conditions: Acute Subdural Hematoma

  1. Comorbid Brain Contusion

VII. Symptoms

  1. Acute (Rapid progression of symptoms)
    1. Headache
    2. Irritability
  2. Chronic (Insidious symptom progression)
    1. Intermittent Headache
    2. Variable levels of Decreased Level of Consciousness

VIII. Signs

  1. Acute (<24 hours)
    1. Fluctuating levels of consciousness
    2. Dilated pupils
    3. Hemiplegia
    4. Hyperreflexia
    5. Babinski's Sign
    6. Convulsions
  2. Subacute (24 hours to 2 weeks)
  3. Chronic (>2 weeks)
    1. Progressively impaired intellect
    2. Agitation
    3. Impulsive behavior
    4. Hemiparesis
    5. Stupor
    6. Variable Level of Consciousness

IX. Imaging: CT Head

  1. Subdural Hematoma appears as crescent-shaped hematoma
  2. Appearance varies based on timing
    1. Acute: White blood collection
    2. Subacute: Isodense blood collection (may be subtle)
    3. Chronic: Dark blood collection

X. Labs: Cerebrospinal fluid

  1. Increased CSF Opening Pressure
  2. CSF Protein increased
  3. CSF Bloody or xanthochromic fluid

XI. Diagnostic Testing: EEG

  1. Localized disturbance

XII. Management

  1. Surgical decompression
    1. Emergency surgical decompression if acute Subdural Hematoma
      1. See Skull Trephination
    2. Over age 65 years old, are unlikely to need surgical intervention if
      1. Midline shift <=1 mm
      2. Width <= 10 mm
      3. Evans (2015) Injury 46(91): 76-9 [PubMed]

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Ontology: Hematoma, Subdural (C0018946)

Definition (SCTSPA) Sangrado hacia el espacio subdural intracraneal
Definition (SCTSPA) Colección de sangre extravascular en el espacio subdural intracraneal
Definition (SNOMEDCT_US) Bleeding into the intracranial subdural space
Definition (SNOMEDCT_US) A collection of extravascular blood in the intracranial subdural space
Definition (NCI_FDA) Cerebral hemorrhage into the subdural space. See also Stroke Syndrome.
Definition (NCI) Cerebral hemorrhage into the subdural space. See also Stroke Syndrome.
Definition (MSH) Accumulation of blood in the SUBDURAL SPACE between the DURA MATER and the arachnoidal layer of the MENINGES. This condition primarily occurs over the surface of a CEREBRAL HEMISPHERE, but may develop in the spinal canal (HEMATOMA, SUBDURAL, SPINAL). Subdural hematoma can be classified as the acute or the chronic form, with immediate or delayed symptom onset, respectively. Symptoms may include loss of consciousness, severe HEADACHE, and deteriorating mental status.
Concepts Pathologic Function (T046)
MSH D006408
ICD9 432.1
SnomedCT 415649003, 35486000, 95453001, 155393009, 313305008
English Hematomas, Subdural, Subdural Hematomas, HAEMORRHAGE SUBDURAL, HEMORRHAGE SUBDURAL, SUBDURAL HAEMATOMA, SUBDURAL HEMATOMA, Subdural Hematoma, Subdural Hemorrhage, Subdural haemorrhage NOS (disorder), subdural hematoma (diagnosis), subdural hematoma, Haemorrhage subdural, Hematoma subdural, Subdural hematonia, Hemorrhage subdural, Hemorrhage, Subdural, Hemorrhages, Subdural, Subdural Hemorrhages, Hematoma, Subdural [Disease/Finding], subdural hematoma (SDH), subdural bleeding, sdh, subdural hemorrhages, Haemorrhage;subdural, subdural haematoma, subdural hematomas, Hematoma, Subdural, Subdural intracranial hemorrhage, Subdural intracranial hematoma (disorder), Subdural intracranial hematoma, Subdural hematoma (disorder), Subdural intracranial haemorrhage, Subdural intracranial hemorrhage (disorder), Subdural intracranial haematoma, Subdural bleeding, subdural hemorrhage (diagnosis), subdural hemorrhage, Subdural hemorrhage (disorder), Subdural hemorrhage NOS, Subdural haematoma (disorder), Haematoma subdural, Subdural hemorrhage NOS (disorder), Subdural haemorrhage NOS, SUBDURAL HEMORRHAGE, HEMORRHAGE, SUBDURAL, Subdural hemorrhage, Subdural hematoma, Subdural haematoma, Subdural haemorrhage, SDH - Subdural haematoma, SDH - Subdural hematoma, hematoma; subdural, hemorrhage; subdural, subdural; hematoma, subdural; hemorrhage, Subdural hematoma, NOS, Subdural hemorrhage, NOS, Subdural hemorrhage [dup] (disorder), Hemorrhage;subdural, subdural haemorrhage
French HEMATOME SOUS-DURAL, Hématonie sous-durale, Hématomes subduraux, Hématome sous-dural, Hématome subdural, HEMORRAGIE SOUS-DURALE, Hématomes sous-duraux, Saignement sous-dural, Hémorragie sous-durale, HSD (Hématome Sous-Dural)
Portuguese HEMATOMA SUBDURAL, HEMORRAGIA SUBDURAL, Sangramento subdural, Hematoma subdural, Hemorragia subdural, Hematoma Subdural, Hemorragia Subdural
Spanish HEMATOMA SUBDURAL, HEMORRAGIA SUBDURAL, Sangrado subdural, hematoma subdural intracraneal, hemorragia subdural, hemorragia subdural intracraneal, hematoma subdural, hematoma subdural intracraneal (trastorno), hemorragia subdural (trastorno), hematoma subdural (trastorno), hemorragia subdural intracraneal (trastorno), hemorragia subdural, SAI (trastorno), hemorragia subdural, SAI, Hematoma subdural, Hemorragia subdural, Hematoma Subdural, Hemorragia Subdural
Dutch hematoom subduraal, subdurale bloeding, bloeding subduraal, hemorragie subduraal, bloeding; subduraal, hematoom; subduraal, subduraal; bloeding, subduraal; hematoom, subduraal hematoom, subdurale hemorragie, Bloeding, subduraal, Hematoom, subduraal, Subduraal hematoom
German Haematom subdural, Blutung subdural, BLUTUNG SUBDURAL, HAEMATOM SUBDURAL, subdurale Blutung, subdurales Haematom, Blutung, subdurale, Subduralblutung, Hämatom, subdurales, Hämorrhagie, subdurale, Subdurales Hämatom
Italian Emorragia all'interno dello spazio subdurale, Emorragia, subdurale, Emorragia dello spazio subdurale, Emorragia subdurale, Sanguinamento subdurale, Ematoma subdurale
Japanese 硬膜下出血, コウマクカシュッケツ, コウマクカケッシュ, 血腫-硬膜下, 硬膜下血腫
Swedish Subduralblödning
Czech hematom subdurální, Subdurální krvácení, Subdurální hematom, Subdurální hemoragie
Finnish Subduraalihematooma
Russian GEMORRAGIIA SUBDURAL'NAIA, GEMATOMA SUBDURAL'NAIA, ГЕМАТОМА СУБДУРАЛЬНАЯ, ГЕМОРРАГИЯ СУБДУРАЛЬНАЯ
Croatian HEMATOM, SUBDURALNI
Polish Krwiak podtwardówkowy
Hungarian Subduralis vérzés, Subduralis haematoma
Norwegian Subduralt hematom, Subduralblødning