Materiały źródłowe

• #1 Subdural Hematoma: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21183-subdural-hematoma

  A subdural hematoma is a type of bleeding near your brain that can happen after a head injury. […] Subdural hematomas can be life-threatening and need immediate medical care. […] A healthcare provider will do a thorough physical and neurological exam. […] If the provider thinks you may have a subdural hematoma, theyll order an imaging test of your head. This may be a computed tomography (CT) scan and/or a magnetic resonance imaging (MRI) scan. These tests allow providers to see clear pictures of your brain and determine the location and amount of bleeding. […] For large or severe subdural hematomas, you usually need surgery. […] If you have a subdural hematoma, your prognosis (outlook) depends on: Your age, The severity of your head injury, How quickly you received treatment. […] Subdural hematomas can be life-threatening. If you have a head injury, get immediate medical attention.

• #2 Subdural hematoma Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/subdural-hematoma

  A subdural hematoma is a collection of blood between the covering of the brain (dura) and the surface of the brain. […] If there is any suspicion of a hematoma, an imaging test, such as a CT or MRI scan, will be done. […] A subdural hematoma is a medical emergency. Call 911 or the local emergency number, or go to an emergency room after a head injury. Do not delay.

• #3

  https://www.nhs.uk/conditions/subdural-haematoma/diagnosis/

  Subdural haematomas are diagnosed based on a person’s medical history, symptoms and the results of a brain scan. […] Most people with a suspected subdural haematoma will have a CT scan to confirm the diagnosis. […] A CT scan uses X-rays and a computer to create detailed images of the inside of your body. […] It can show whether any blood has collected between your skull and your brain. […] In a few cases, an MRI scan may be used to check for a subdural haematoma instead.

• #4 Subdural Hematoma Workup: Approach Considerations, Coagulation Profile, Computed Tomography

  https://emedicine.medscape.com/article/1137207-workup

  An emergent computed tomography (CT) scan of the head needs to be performed when an acute SDH is suspected. It should be obtained immediately after the patient is stabilized using standard Advanced Trauma Life Support (ATLS) guidelines. CT scanning is also the initial imaging modality of choice for chronic SDH. […] The trauma team and neurosurgeon must determine quickly which lesions warrant immediate evacuation, and CT is the imaging modality of choice to facilitate this decision. Modern CT devices can produce appropriate images in about 5 minutes, and the scans are highly sensitive to acute blood. Although magnetic resonance imaging (MRI) is superior for demonstrating the size of an acute SDH and its effect on the brain, noncontrast head CT is the primary means of making a diagnosis and suffices for immediate management purposes.

• #5 Subdural Hematoma Workup: Approach Considerations, Coagulation Profile, Computed Tomography

  https://emedicine.medscape.com/article/1137207-workup

  An emergent computed tomography (CT) scan of the head needs to be performed when an acute SDH is suspected. It should be obtained immediately after the patient is stabilized using standard Advanced Trauma Life Support (ATLS) guidelines. CT scanning is also the initial imaging modality of choice for chronic SDH. […] The trauma team and neurosurgeon must determine quickly which lesions warrant immediate evacuation, and CT is the imaging modality of choice to facilitate this decision. Modern CT devices can produce appropriate images in about 5 minutes, and the scans are highly sensitive to acute blood. Although magnetic resonance imaging (MRI) is superior for demonstrating the size of an acute SDH and its effect on the brain, noncontrast head CT is the primary means of making a diagnosis and suffices for immediate management purposes.

• #6 Subdural Hematoma Imaging: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/344482-overview

  Subdural hematoma (SDH) is a type of bleeding in which a collection of blood gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. […] CT is now the first step in diagnosis of SDH. MRI is considered an excellent imaging tool for evaluating such patients. […] CT scanning is usually the first evaluation in patients with suspected acute SDH because CT depicts acute hemorrhage and skull fractures well, it is relatively fast to obtain, and CT scanning is more readily available than MRI. […] MRI is more sensitive than CT in detecting SDH because multiplanar capabilities and superior tissue differentiation of MRI make detection easier. […] The presence of interleukin (IL)-6 and IL-8 on hyperintense T1-weighted images and evidence of beta-trace proteins on hyperintense T2-weighted images appear to be associated with rebleeding and CSF admixure in chronic SDH.

• #7

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4556906/

  If the CT examination is currently very easily accessible, the diagnosis of chronic subdural haematoma has become quite simple, the main condition being that you only have to think about such a diagnosis. […] The diagnosis of chronic subdural haematoma has evolved in the last 20-30 years together with the introduction of the CT scan, the MRI and the access of the patients to this type of explorations. […] The CT scan is an essential tool in emergency brain injuries traumas. […] The MRI examination better shows the location of the chronic subdural haematoma and evidences its dimensions much clearer together with the mass effect of the adjacent structures. […] Over the years, together with the development of the diagnosis methods and the surgical techniques, the treatment of chronic subdural haematomas has evolved; currently there are also studies of conservative treatment beside the various surgical techniques, which however have not been applied very often.

• #8 Subdural Hematoma Workup: Approach Considerations, Coagulation Profile, Computed Tomography

  https://emedicine.medscape.com/article/1137207-workup

  For this reason, either contrast-enhanced CT or MRI should be considered for imaging 4872 hours after head injury. […] In the chronic phase, the lesion becomes hypodense and is easy to appreciate on a noncontrast head CT scan. […] Although the distinction between subacute and chronic is an arbitrary one, it can be important. Chronic SDHs have a liquid consistency, typically resembling crankcase oil, and can be drained through burr holes. The consistency of subacute SDHs might be too thick for burr-hole drainage and might require craniotomy. […] MRI is less useful than CT in diagnosing an acute SDH because of the increased time needed to obtain the study and the inability to use metallic objects that are needed to resuscitate patients with trauma in the scanning environment. […] MRI can be a useful study to evaluate associated parenchymal brain injury and predict prognosis, but only after stabilizing and treating any life-threatening lesions.

• #9 Subdural hematoma – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/subdural-hematoma/

  Subdural hematoma (SDH) refers to bleeding into the intracranial subdural space that is typically caused by a rupture of the bridging veins. […] Diagnosis is confirmed with a noncontrast head CT, which would show a crescent-shaped (concave) lesion that may cross cranial sutures typically located in the supratentorial region. […] Immediate initiation of neuroprotective measures takes precedence over diagnostics in patients with acutely symptomatic SDH. […] Diagnostics should not delay the transfer of a patient to a neurocritical care unit if needed. […] In trauma patients, findings of other injuries often accompany SDH, e.g., skull fractures, cerebral edema, and other types of TBI. […] CT head without IV contrast: Indication: first-line imaging modality for suspected acute SDH. […] Characteristic findings: Crescent-shaped, concave, sharply demarcated extraaxial lesion. […] MRI head: Indications: Neurological features unexplained by CT findings. […] Angiography: Indication: to determine the etiology of a nontraumatic SDH (e.g., ruptured aneurysm, vascular meningeal tumor, AVM).

• #10 Subdural hemorrhage | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/subdural-hemorrhage-2?lang=us

  Subdural hemorrhage/hematoma (SDH) is a collection of blood accumulating in the subdural space. […] CT scans are usually sufficient to make the diagnosis. […] In the vast majority of cases, CT scans are sufficient to make the diagnosis and manage these patients. […] Treatment depends primarily on the amount of mass-effect and neurological impairment caused by the collection, and thus correlates with the size of the subdural hemorrhage. […] Symptomatic collections need to be surgically evacuated. […] The classic appearance of an acute subdural hematoma is a crescent-shaped homogeneously hyperdense extra-axial collection that spreads diffusely over the affected hemisphere. […] By definition, the subdural hemorrhage is at least 3 weeks old. […] Rarely, the periphery of the subdural hemorrhage may calcify.

• #11 Subdural Hematoma Workup: Approach Considerations, Coagulation Profile, Computed Tomography

  https://emedicine.medscape.com/article/1137207-workup

  A worsening of the Glasgow Coma Scale by 2 or more points should prompt repeat imaging in salvageable patients. A cervical spine radiograph series is important in evaluating the possibility of concomitant cervical spine fracture. […] Coagulation profiles are particularly important for patients taking anticoagulants and for alcoholics, who may have an associated coagulopathy placing them at high risk for subdural hematoma. […] In addition, the prevalence of coagulation abnormalities has long been recognized as unusually high in patients with head injuries. […] On noncontrast CT scan, an acute SDH appears as a hyperdense (white), crescent-shaped mass between the inner table of the skull and the surface of the cerebral hemisphere. […] Acute subdural hematomas occur most commonly over the cerebral convexity in the parietal region.

• #12 Subdural hematoma – Wikipedia

  https://en.wikipedia.org/wiki/Subdural_hematoma

  A subdural hematoma (SDH) is a type of bleeding in which a collection of blood usually but not always associated with a traumatic brain injury gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. […] It is important that a person receive medical assessment, including a complete neurological examination, after any head trauma. A CT scan or MRI scan will usually detect significant subdural hematomas. […] Subdural hematomas occur most often around the tops and sides of the frontal and parietal lobes. […] On a CT scan, subdural hematomas are classically crescent-shaped, with a concave surface away from the skull. […] Subdural hematomas are classified as acute, subacute, or chronic, depending on the speed of their onset. […] Acute subdural hematomas due to trauma are the most lethal of all head injuries and have a high mortality rate if they are not rapidly treated with surgical decompression. […] Chronic subdural hematomas (CSDHs) have a relatively high mortality rate (up to 16.7% in patients over the age of 65); however, they have an even higher rate of recurrence.

• #13 Subdural hemorrhage | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/subdural-hemorrhage-2?lang=us

  Subdural hemorrhage/hematoma (SDH) is a collection of blood accumulating in the subdural space. […] CT scans are usually sufficient to make the diagnosis. […] In the vast majority of cases, CT scans are sufficient to make the diagnosis and manage these patients. […] Treatment depends primarily on the amount of mass-effect and neurological impairment caused by the collection, and thus correlates with the size of the subdural hemorrhage. […] Symptomatic collections need to be surgically evacuated. […] The classic appearance of an acute subdural hematoma is a crescent-shaped homogeneously hyperdense extra-axial collection that spreads diffusely over the affected hemisphere. […] By definition, the subdural hemorrhage is at least 3 weeks old. […] Rarely, the periphery of the subdural hemorrhage may calcify.

• #14 Subdural Hematoma Workup: Approach Considerations, Coagulation Profile, Computed Tomography

  https://emedicine.medscape.com/article/1137207-workup

  For this reason, either contrast-enhanced CT or MRI should be considered for imaging 4872 hours after head injury. […] In the chronic phase, the lesion becomes hypodense and is easy to appreciate on a noncontrast head CT scan. […] Although the distinction between subacute and chronic is an arbitrary one, it can be important. Chronic SDHs have a liquid consistency, typically resembling crankcase oil, and can be drained through burr holes. The consistency of subacute SDHs might be too thick for burr-hole drainage and might require craniotomy. […] MRI is less useful than CT in diagnosing an acute SDH because of the increased time needed to obtain the study and the inability to use metallic objects that are needed to resuscitate patients with trauma in the scanning environment. […] MRI can be a useful study to evaluate associated parenchymal brain injury and predict prognosis, but only after stabilizing and treating any life-threatening lesions.

• #15 Subdural Haematoma – Clinical Features – Management – TeachMeSurgery

  https://teachmesurgery.com/neurosurgery/traumatic-injuries/subdural-haematoma/

  A subdural haematoma (SDH) is a collection of blood that forms in the subdural space, the space between the dura mater and the arachnoid mater. […] They can be classified as acute (3 days after injury), subacute (3-21 days), or chronic SDH (21 days), or as simple (no associated parenchymal injury) versus complicated (associated underlying parenchymal injury). […] The gold-standard initial imaging modality for a suspected SDH is a non-contrast CT scan of the head. SDH should show a crescent-shaped collection of blood over one hemisphere, with or without associated midline shift. […] Management should be based on the size and clinical features, and indeed not all cases require surgery. […] Gold standard initial investigation is via non-contrast head CT scan.

• #16 Subdural Hematoma Workup: Approach Considerations, Coagulation Profile, Computed Tomography

  https://emedicine.medscape.com/article/1137207-workup

  For this reason, either contrast-enhanced CT or MRI should be considered for imaging 4872 hours after head injury. […] In the chronic phase, the lesion becomes hypodense and is easy to appreciate on a noncontrast head CT scan. […] Although the distinction between subacute and chronic is an arbitrary one, it can be important. Chronic SDHs have a liquid consistency, typically resembling crankcase oil, and can be drained through burr holes. The consistency of subacute SDHs might be too thick for burr-hole drainage and might require craniotomy. […] MRI is less useful than CT in diagnosing an acute SDH because of the increased time needed to obtain the study and the inability to use metallic objects that are needed to resuscitate patients with trauma in the scanning environment. […] MRI can be a useful study to evaluate associated parenchymal brain injury and predict prognosis, but only after stabilizing and treating any life-threatening lesions.

• #17 Management of Chronic Subdural Hematoma a Challenge in Neurosurgical Practice

  https://e-jnic.org/journal/view.php?number=89

  Chronic subdural hematoma (CSDH) is a common neurosurgical disease encountered by neurologists, neurosurgeons, intensive care specialists, and emergency physicians in the emergency department. […] The diagnosis of chronic subdural hematoma is made through neuroimaging, the study of choice is non-contrast computed tomography of the skull, given its high availability and non-invasive nature. […] The computed Tomography Scan (CT-Scan) is the main imaging modality for CSDH diagnosis; however, Magnetic Resonance Imaging (MRI) is also useful but not preferred. […] The characteristic of the image obtained in this pathology is a crescent formation due to the collection of blood products in the subdural space, between the arachnoid and the dura mater; Radiodensity measured in Hounsfield units depends on the time of evolution of the lesion due to hemosiderin degradation.

• #18 Management of Chronic Subdural Hematoma a Challenge in Neurosurgical Practice

  https://e-jnic.org/journal/view.php?number=89

  In this type of image, it is expected to find hyperintensity in T1 and hypointensity in T2, due to the concentration of proteins, an aspect that allows differentiation with cerebrospinal fluid. […] The use of nuclear magnetic resonance has increased over time due to its increased availability. […] The patients undergoing surgery have been studied with tomography, and different studies propose postoperative volume as the greatest predictor of recurrence, beyond clinical or other imaging predictors. […] Given the characteristics of this pathology, possible differentials are hygromas, defined as a collection of cerebrospinal fluid in the subdural space due to traumatic injury to the arachnoid or non-traumatic causes such as hypotension, dehydration, and atrophy, which cannot be easily distinguished from subdural hematomas.

• #19 Subdural Hematoma Imaging: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/344482-overview

  Subdural hematoma (SDH) is a type of bleeding in which a collection of blood gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. […] CT is now the first step in diagnosis of SDH. MRI is considered an excellent imaging tool for evaluating such patients. […] CT scanning is usually the first evaluation in patients with suspected acute SDH because CT depicts acute hemorrhage and skull fractures well, it is relatively fast to obtain, and CT scanning is more readily available than MRI. […] MRI is more sensitive than CT in detecting SDH because multiplanar capabilities and superior tissue differentiation of MRI make detection easier. […] The presence of interleukin (IL)-6 and IL-8 on hyperintense T1-weighted images and evidence of beta-trace proteins on hyperintense T2-weighted images appear to be associated with rebleeding and CSF admixure in chronic SDH.

• #20 Subdural Hematoma: Symptoms, Diagnosis, and Treatments

  https://www.healthline.com/health/subdural-hematoma

  A subdural hematoma can be diagnosed using imaging tests, like a CT or MRI scan. These scans provide your doctor with an in-depth look at your: […] These scans can also reveal if theres any blood on the surface of your brain. […] Your doctor may also order a blood test to check your complete blood count (CBC). A CBC test measures your red blood cell count, white blood cell count, and platelet count. A low level of red blood cells can mean youve had significant blood loss. […] Your doctor may also give you a physical exam to check your heart rate and blood pressure for evidence of internal bleeding.

• #21 Subdural Hematoma Workup: Approach Considerations, Coagulation Profile, Computed Tomography

  https://emedicine.medscape.com/article/1137207-workup

  A worsening of the Glasgow Coma Scale by 2 or more points should prompt repeat imaging in salvageable patients. A cervical spine radiograph series is important in evaluating the possibility of concomitant cervical spine fracture. […] Coagulation profiles are particularly important for patients taking anticoagulants and for alcoholics, who may have an associated coagulopathy placing them at high risk for subdural hematoma. […] In addition, the prevalence of coagulation abnormalities has long been recognized as unusually high in patients with head injuries. […] On noncontrast CT scan, an acute SDH appears as a hyperdense (white), crescent-shaped mass between the inner table of the skull and the surface of the cerebral hemisphere. […] Acute subdural hematomas occur most commonly over the cerebral convexity in the parietal region.

• #22 Controversies in the Surgical Treatment of Chronic Subdural Hematoma: A Systematic Scoping Review

  https://www.mdpi.com/2075-4418/12/9/2060

  Chronic subdural hematoma (cSDH) is one of the most common neurosurgical entities, especially in the elderly population. Diagnosis is usually established via a head computed tomography, while an increasing number of studies are investigating biomarkers to predict the natural history of cSDH, including progression and recurrence. […] The clinical appearance of cSDH varies considerably: some patients are asymptomatic; some present with symptoms such as headache, walking instability, cognitive impairment or focal neurological deficits; while others have a severe clinical presentation, with stupor or even coma. […] As symptoms are nonspecific, diagnosis is usually confirmed with non-contrast computed tomography (CT) of the head, or more rarely, magnetic resonance imaging (MRI). […] Research is focusing on several biomarkers such as inflammatory cell ratio, activated partial thromboplastin time and prothrombin time to assess cSDH severity and surgical outcome.

• #23 Subdural haematoma – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/416

  Subdural haematoma (SDH) has a variable disease course, depending on size of haematoma, age of the patient, presenting neurological signs/symptoms, presence of underlying coagulopathy or neoplasm, and associated injuries. […] While the presence of SDH can be inferred by neurological decline and mechanism of traumatic injury, the diagnosis is typically made radiographically (computed tomography or magnetic resonance imaging). […] Key diagnostic factors include presence of risk factors, evidence of trauma, headache, nausea/vomiting, diminished eye response, diminished verbal response, diminished motor response, and confusion. […] The first test to order is a non-contrast CT scan. […] Tests to consider include MRI scan and plain skull x-ray.

• #24 Subdural Hematoma – Harvard Health

  https://www.health.harvard.edu/a_to_z/subdural-hematoma-a-to-z

  A subdural hematoma occurs when a blood vessel near the surface of the brain bursts. Blood builds up between the brain and the brain’s tough outer lining. The condition is also called a subdural hemorrhage. […] A subdural hematoma is a life-threatening problem because it can compress the brain. […] An acute subdural hemorrhage is bleeding that develops shortly after a serious blow to the head. Blood accumulates rapidly, causing pressure to rise within the brain. This can result in loss of consciousness, paralysis, or death. […] When bleeding develops slowly, it is known as a chronic subdural hemorrhage. Bleeding may develop over a period of weeks to months. […] A doctor usually will want to know how the injury occurred, what symptoms developed, whether there have been head injuries in the past, whether the person has other medical problems, what medications the person is taking, whether the person has been drinking alcohol or using drugs, and whether there are symptoms of other injuries.

• #25 Subdural haematoma – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/416

  Subdural haematoma (SDH) has a variable disease course, depending on size of haematoma, age of the patient, presenting neurological signs/symptoms, presence of underlying coagulopathy or neoplasm, and associated injuries. […] While the presence of SDH can be inferred by neurological decline and mechanism of traumatic injury, the diagnosis is typically made radiographically (computed tomography or magnetic resonance imaging). […] Key diagnostic factors include presence of risk factors, evidence of trauma, headache, nausea/vomiting, diminished eye response, diminished verbal response, diminished motor response, and confusion. […] The first test to order is a non-contrast CT scan. […] Tests to consider include MRI scan and plain skull x-ray.

• #26 Subdural hematoma – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/416

  Subdural hematoma (SDH) has a 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. […] While the presence of SDH can be inferred by neurologic decline and mechanism of traumatic injury, the diagnosis is typically made radiographically (computed tomography or magnetic resonance imaging). […] Key diagnostic factors include evidence of trauma, headache, nausea/vomiting, diminished eye response, diminished verbal response, diminished motor response, and confusion. […] The first test to order is a noncontrast CT scan. […] Tests to consider include MRI scan and plain skull x-ray.

• #27 Management of Chronic Subdural Hematoma a Challenge in Neurosurgical Practice

  https://e-jnic.org/journal/view.php?number=89

  In this type of image, it is expected to find hyperintensity in T1 and hypointensity in T2, due to the concentration of proteins, an aspect that allows differentiation with cerebrospinal fluid. […] The use of nuclear magnetic resonance has increased over time due to its increased availability. […] The patients undergoing surgery have been studied with tomography, and different studies propose postoperative volume as the greatest predictor of recurrence, beyond clinical or other imaging predictors. […] Given the characteristics of this pathology, possible differentials are hygromas, defined as a collection of cerebrospinal fluid in the subdural space due to traumatic injury to the arachnoid or non-traumatic causes such as hypotension, dehydration, and atrophy, which cannot be easily distinguished from subdural hematomas.

• #28 Etiological differential diagnosis of the acute subdural hematoma in pediatric age | Spanish Journal of Legal Medicine

  https://www.elsevier.es/es-revista-spanish-journal-legal-medicine-446-resumen-etiological-differential-diagnosis-acute-subdural-S2445424922000218

  Funduscopy is essential for the correct diagnosis of ASHs. […] Although less common, there are numerous non-traumatic causes of infantile ASHs. […] Computed tomography (CT) of the skull is the test of choice in cases of traumatic brain injury and is useful to observe cranial fractures and acute bleedings. […] The presence of fractures in the posterior rib arches, metaphyseal, or diaphyseal fractures in the long bones is highly suggestive of child abuse. […] The aetiological diagnosis of ASH in children is a clinical challenge for the different specialists involved in the management of the patient. These haematomas are frequently of traumatic aetiology. However, differential diagnosis with spontaneous haematomas is raised and, within traumatic haematomas, the main diagnostic challenge is to differentiate between accidental trauma and intentional trauma in the context of child abuse.

• #29

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4556906/

  A developed society is usually also characterized by an elderly population, which has a continuous percentage growth. […] Chronic subdural pathologies represent an affection frequently met in neurosurgery practice. Any neurosurgeon, neurologist and not only, has to be aware of the possibility of the existence of a chronic subdural haematoma, especially when the patient is old and is subjected to an anticoagulant or antiaggregant treatment, these 2 causes being by far the etiological factors most frequently met in chronic subdural haematomas. […] The diagnosis of a chronic subdural haematoma can present many difficulties taking into account the fact that it frequently appears in elders, who anyway have a higher or a lower degree of psychical disorders due to brain involution. […] The suspicion of expansive intracranial injury makes us perform a paraclinical investigation (CT or MRI), which makes the diagnosis clearer by evidencing the iso- or hypodense subdural collection.

• #30 What to Know About Subdural Hematoma | AdventHealth Orlando

  https://www.adventhealth.com/hospital/adventhealth-orlando/blog/what-know-about-subdural-hematoma

  Subdural hematomas are pools of blood that collect between brains protective covering (called the dura) and the brain itself. They form after a head injury, such as a car accident or a fall. […] It’s important to distinguish that there are two types of subdural hematomas. Acute subdural hematomas develop and cause symptoms immediately or within hours of a head injury. They are usually diagnosed by a CAT scan in the ER and often require emergency surgery. Chronic subdural hematomas can be more complex because they commonly present four to six weeks after the head injury took place. […] In both types, subdural hematomas range in severity. […] If not found and treated, they can quickly become life-threatening. […] An important distinction to make is that some subdural hematomas do resolve on their own, such as those that are small or not causing symptoms.

• #31 Chronic Subdural Hematomas – Neurosurgery | UCLA Health

  https://www.uclahealth.org/medical-services/neurosurgery/conditions-treated/chronic-subdural-hematomas

  A chronic subdural hematoma (SDH) is an old clot of blood on the surface of the brain beneath its outer covering. […] Diagnosis involves computed tomography (CT) and magnetic resonance imaging (MRI) brain scans. SDHs vary in density and may extend over a large portion of the surface of the brain. […] An initial misdiagnosis of dementia is particularly common in elderly patients where symptoms involved a steady decline in overall mental function. An errant diagnosis at the time of hospital admission occurs in up to 40 percent of cases.

• #32 Etiological differential diagnosis of the acute subdural hematoma in pediatric age | Spanish Journal of Legal Medicine

  https://www.elsevier.es/es-revista-spanish-journal-legal-medicine-446-resumen-etiological-differential-diagnosis-acute-subdural-S2445424922000218

  This article is focused on the differential diagnosis of infantile acute subdural haematoma (SDH). The objective is focus on bringing more diagnostic tools when it comes to differentiate an spontaneous SDH from the traumatic SDH, being this accidental or intentional in the context of a child abuse. A complete state of the art is made from the review of the most recent available literature, collecting in the same paper the most relevant clinical features, radiologic findings and anatomopatological criteria for the diagnosis of infantile SDH. […] Currently, in clinical practice, the first issue in the diagnosis of ASH is whether it was caused by accidental trauma or whether it is the result of intentional trauma. This diagnosis is difficult and highly controversial because of the serious clinical, social and medico-legal implications associated with the diagnosis of child abuse.

• #33 Etiological differential diagnosis of the acute subdural hematoma in pediatric age | Spanish Journal of Legal Medicine

  https://www.elsevier.es/es-revista-spanish-journal-legal-medicine-446-resumen-etiological-differential-diagnosis-acute-subdural-S2445424922000218

  Funduscopy is essential for the correct diagnosis of ASHs. […] Although less common, there are numerous non-traumatic causes of infantile ASHs. […] Computed tomography (CT) of the skull is the test of choice in cases of traumatic brain injury and is useful to observe cranial fractures and acute bleedings. […] The presence of fractures in the posterior rib arches, metaphyseal, or diaphyseal fractures in the long bones is highly suggestive of child abuse. […] The aetiological diagnosis of ASH in children is a clinical challenge for the different specialists involved in the management of the patient. These haematomas are frequently of traumatic aetiology. However, differential diagnosis with spontaneous haematomas is raised and, within traumatic haematomas, the main diagnostic challenge is to differentiate between accidental trauma and intentional trauma in the context of child abuse.

• #34 Subdural Hematoma Workup: Approach Considerations, Coagulation Profile, Computed Tomography

  https://emedicine.medscape.com/article/1137207-workup

  A worsening of the Glasgow Coma Scale by 2 or more points should prompt repeat imaging in salvageable patients. A cervical spine radiograph series is important in evaluating the possibility of concomitant cervical spine fracture. […] Coagulation profiles are particularly important for patients taking anticoagulants and for alcoholics, who may have an associated coagulopathy placing them at high risk for subdural hematoma. […] In addition, the prevalence of coagulation abnormalities has long been recognized as unusually high in patients with head injuries. […] On noncontrast CT scan, an acute SDH appears as a hyperdense (white), crescent-shaped mass between the inner table of the skull and the surface of the cerebral hemisphere. […] Acute subdural hematomas occur most commonly over the cerebral convexity in the parietal region.

• #35 Subdural Hematoma – Harvard Health

  https://www.health.harvard.edu/a_to_z/subdural-hematoma-a-to-z

  If the doctor suspects bleeding in the head, he or she will usually order a computer tomography (CT) scan. A CT scan is the fastest way to determine the location and amount of bleeding. […] A doctor may suspect a chronic subdural hemorrhage if an older patient develops new neurological symptoms. […] An acute subdural hemorrhage requires immediate medical attention. In most cases, emergency surgery must be done to drain the hematoma and to control bleeding. […] In contrast, only some chronic subdural hemorrhages require emergency surgery. Most physicians will recommend surgery for larger hemorrhages and those that cause neurological symptoms.

• #36 Subdural Haematoma: Symptoms and Treatment | Doctor

  https://patient.info/doctor/subdural-haematoma-pro

  A subdural haematoma (SDH) is a collection of clotting blood that forms in the subdural space. This may be: […] Diagnosing subdural haematomas (investigations) […] In patients with impaired consciousness, confusion, focal neurology or signs of possible raised intracranial pressure, that cannot be otherwise explained, urgent neuroimaging is mandatory. […] CT scan of the head is good for detecting acute SDH and is mandatory in children with significant head injury. […] Subacute SDH may be more difficult to detect, so CT with contrast or MRI is preferred. […] Chronic SDH is usually detectable on CT scan. […] If the condition is strongly suspected or confirmed by investigation, refer urgently to the neurosurgical team. […] Surgery is needed if there are focal signs, deterioration, a large haematoma, raised intracranial pressure or midline shift. […] SDH is treated by emergency craniotomy, or decompressive craniectomy and clot evacuation. […] There is a growing body of evidence for using middle meningeal artery embolisation to treat chronic subdural haematoma as recurrence may occur in 5-30% of those treated with burr hole or craniectomy.

• #37 Subdural Hematoma

  https://fpnotebook.com/Neuro/CV/SbdrlHmtm.htm

  Subdural Hematoma appears as crescent-shaped Hematoma. […] As this is below the dura, the Subdural Hematoma follows the surface of the brain. […] Gyri are absent in region of Subdural Hematoma. […] Helps identify subacute Subdural Hematoma which is isodense and more difficult to distinguish. […] Increased CSF Opening Pressure. […] CSF Protein increased. […] CSF Bloody or xanthochromic fluid. […] Admit all patients with chronic or acute Subdural Hematoma (SDH). […] Anticoagulation and antiplatelet agent use predisposes to subdural expansion. […] Manage systolic Blood Pressure, targets per neurosurgery, but typically 180 mmHg. […] Surgical decompression. […] Indications: Subdural thickness 10 mm. […] Midline shift 5 mm. […] Glasgow Coma Scale decreases 2 points from initial injury.

• #38 Subdural Hematoma Imaging: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/344482-overview

  Subdural hematoma (SDH) is a type of bleeding in which a collection of blood gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. […] CT is now the first step in diagnosis of SDH. MRI is considered an excellent imaging tool for evaluating such patients. […] CT scanning is usually the first evaluation in patients with suspected acute SDH because CT depicts acute hemorrhage and skull fractures well, it is relatively fast to obtain, and CT scanning is more readily available than MRI. […] MRI is more sensitive than CT in detecting SDH because multiplanar capabilities and superior tissue differentiation of MRI make detection easier. […] The presence of interleukin (IL)-6 and IL-8 on hyperintense T1-weighted images and evidence of beta-trace proteins on hyperintense T2-weighted images appear to be associated with rebleeding and CSF admixure in chronic SDH.

• #39 Subdural Hematoma Imaging: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/344482-overview

  Preoperative findings on MRI, particularly T1-weighted classification, have been found to be a significant indicator of recurrence of chronic SDH, with T1-iso/hypointensity determined to be a high indicator of risk (18.2% recurrence rate vs 5.2% for other indicators). […] Detection and severity assessment of SDH is a major step in the evaluation of TBI.

• #40

  https://link.springer.com/article/10.1007/BF00395337

  CT findings in 51 patients with subdural hematomas are studied. Direct signs (hyperdensity, hypodensity) and indirect signs (any form of mass lesion) are distinguished. […] CT is limited with regard to determining correlations between time and the attenuation values. The factors which influence density of the hematoma are discussed. For a rational approach with subdural hematomas, which present diagnostic problems and reveal the limitations of CT diagnosis, a diagnostic scheme is proposed.

• #41

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4556906/

  A developed society is usually also characterized by an elderly population, which has a continuous percentage growth. […] Chronic subdural pathologies represent an affection frequently met in neurosurgery practice. Any neurosurgeon, neurologist and not only, has to be aware of the possibility of the existence of a chronic subdural haematoma, especially when the patient is old and is subjected to an anticoagulant or antiaggregant treatment, these 2 causes being by far the etiological factors most frequently met in chronic subdural haematomas. […] The diagnosis of a chronic subdural haematoma can present many difficulties taking into account the fact that it frequently appears in elders, who anyway have a higher or a lower degree of psychical disorders due to brain involution. […] The suspicion of expansive intracranial injury makes us perform a paraclinical investigation (CT or MRI), which makes the diagnosis clearer by evidencing the iso- or hypodense subdural collection.

• #42 Etiological differential diagnosis of the acute subdural hematoma in pediatric age | Spanish Journal of Legal Medicine

  https://www.elsevier.es/es-revista-spanish-journal-legal-medicine-446-resumen-etiological-differential-diagnosis-acute-subdural-S2445424922000218

  At present, there are no clear algorithms available, nor sufficiently contrasted and rigorous data to enable a systematic and accurate aetiological diagnosis of ASH in children. Moreover, existing algorithms tend to exclude spontaneous causes in their aetiological diagnosis and focus, like most of the literature, on traumatic causes. […] The clinical picture of a subdural haematoma is often non-specific and with a highly broad spectrum of severity, which complicates its diagnosis in the emergency department. In most cases, the symptoms appear immediately after the injury, whether intentional or accidental. […] The clinical diagnosis of ASH always requires a thorough physical examination and a multidisciplinary approach. […] The examination allows us to detect possible injuries associated with child abuse, such as blunt injuries in generally „non-traumatisable” locations, as well as suspected bone fractures.

• #43 Etiological differential diagnosis of the acute subdural hematoma in pediatric age | Spanish Journal of Legal Medicine

  https://www.elsevier.es/es-revista-spanish-journal-legal-medicine-446-resumen-etiological-differential-diagnosis-acute-subdural-S2445424922000218

  The literature review shows that there is currently no algorithm that clearly defines the aetiological diagnosis of ASH. […] In order to try to avoid these false positives and negatives, we believe it is important to individualise the diagnosis, taking into account both traumatic and spontaneous causes. […] This paper has focused on the aetiological differential diagnosis of childhood ASH. The review carried out shows, firstly, the need to continue to deepen our knowledge of the pathophysiology of traumatic ASH, especially in cases of abuse by shaking and, secondly, the lack of consensus and systematisation when it comes to approaching the differential diagnosis of infantile ASH.

• #44

  https://www.ijcmph.com/index.php/ijcmph/article/view/3625/0

  Subdural hematoma is diagnosed using CT or MRI imaging. […] Acute subdural hematoma is an emergency and requires prompt diagnosis using CT most of the time, and management requires surgery as well as reversal of anticoagulants. […] Subdural hematoma are clinical emergencies that require immediate and rapid management to prevent significant morbidity and mortality. […] Controlling intracranial pressure is an important factor for predicting the outcomes of subdural hematoma, and should thus be continuously monitored and corrected.

• #45 Subdural hematoma: Definition, treatment, and outlook

  https://www.medicalnewstoday.com/articles/320259

  A person with a head injury requires immediate medical attention. […] One type of internal bleeding in the skull is called subdural hematoma. […] It is important to diagnose cases of acute subdural hematoma quickly so treatment can begin immediately. Rapid treatment may minimize the risk of death or long-term effects. […] Cases of chronic subdural hematoma may be more difficult to diagnose, as symptoms do not develop rapidly or may not have an obvious cause. […] To diagnose subdural hematoma, a doctor will usually use computed tomography (CT), or magnetic resonance imaging (MRI) scans to get a clear picture of the brain. […] If the doctor identifies bleeding, they will determine the source of the bleeding and develop a plan of action to address the issue.

• #46 Subdural Hematoma Symptoms and Diagnosis – Acibadem Health Point – ACIBADEM Hospitals – Acibadem Health Group

  https://www.acibademhealthpoint.com/subdural-hematoma-symptoms-and-diagnosis/

  Early diagnosis is key in treating subdural hematomas. It greatly helps in improving treatment results and outcomes. Finding the condition early means quick action, which is vital to lessen serious health issues. […] The Journal of Neurosurgery also found a link between early diagnosis and better health outcomes. Patients who got help fast had shorter stays in the hospital and recovered better. […] Subdural hematoma shows we need a detailed and careful way of treating patients. By understanding the different symptoms and signs, doctors can give the best care to each patient.

• #47 Subdural Hematoma: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21183-subdural-hematoma

  A subdural hematoma is a type of bleeding near your brain that can happen after a head injury. […] Subdural hematomas can be life-threatening and need immediate medical care. […] A healthcare provider will do a thorough physical and neurological exam. […] If the provider thinks you may have a subdural hematoma, theyll order an imaging test of your head. This may be a computed tomography (CT) scan and/or a magnetic resonance imaging (MRI) scan. These tests allow providers to see clear pictures of your brain and determine the location and amount of bleeding. […] For large or severe subdural hematomas, you usually need surgery. […] If you have a subdural hematoma, your prognosis (outlook) depends on: Your age, The severity of your head injury, How quickly you received treatment. […] Subdural hematomas can be life-threatening. If you have a head injury, get immediate medical attention.

• #48 Chronic Subdural Hematoma: „Symptoms Are Indefinite, and the Diagnosis Cannot Be Made With Certainty”

  https://www.patientcareonline.com/view/chronic-subdural-hematoma-symptoms-are-indefinite-and-diagnosis-cannot-be-made-certainty

  A 69-year-old retired accountant presents with a 2-month history of daily headaches. […] He did order a noncontrast brain CT for this patient. It showed a large left-sided, hyperdense lesion that extended from the frontal to the parietal lobe with blood in the ventricles. […] It is difficult to diagnose CSH based on the clinical picture alone. William Osler remarked that „the symptoms are indefinite, and the diagnosis cannot be made with certainty.” […] With a high index of suspicion and brain CT scanning, however, the diagnosis of CSH can be established with certainty.

• #49

  https://continentalhospitals.com/diseases/subdural-hemorrhage/

  Accurate and timely diagnosis of subdural hemorrhage is crucial for effective treatment and management. […] One of the primary methods used in the diagnosis of subdural hemorrhage is neuroimaging. Imaging techniques such as computed tomography (CT) scans or magnetic resonance imaging (MRI) can provide detailed images of the brain, allowing doctors to visualize any bleeding or blood clots in the subdural space. […] Furthermore, laboratory tests may be conducted to evaluate blood clotting factors or rule out other potential causes of bleeding within the brain. […] It is important to note that prompt diagnosis is essential as delays can lead to worsening symptoms and potentially life-threatening complications. Therefore, healthcare professionals must remain vigilant when evaluating patients who present with symptoms suggestive of subdural hemorrhage. […] By utilizing a combination of neuroimaging techniques, clinical evaluation, and laboratory tests when necessary, healthcare providers can accurately diagnose subdural hemorrhage and initiate appropriate treatment strategies promptly.

• #50

  https://www.ijcmph.com/index.php/ijcmph/article/view/3625/0

  Subdural hematoma is diagnosed using CT or MRI imaging. […] Acute subdural hematoma is an emergency and requires prompt diagnosis using CT most of the time, and management requires surgery as well as reversal of anticoagulants. […] Subdural hematoma are clinical emergencies that require immediate and rapid management to prevent significant morbidity and mortality. […] Controlling intracranial pressure is an important factor for predicting the outcomes of subdural hematoma, and should thus be continuously monitored and corrected.

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