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Highlights & Basics
- 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.
- One week of prophylactic anticonvulsants (e.g., phenytoin, levetiracetam) should be considered in all cases of acute and acute-on-chronic SDH, according to the Brain Trauma Foundation guidelines.
- Tailored management and reversal of antithrombotic therapy is a key element of initial care for all patients with SDH.
- The choice between surgery or conservative management for SDH is typically based on hematoma size, extent of midline shift, severity of neurologic dysfunction and degree of elevated intracranial pressure (ICP). The degree of surgical risk and potential for recovery may also be considered.
- Observation may be employed for small, stable SDHs that are not causing neurologic compromise.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
CT scan of the brain of an 80-year-old man with a gait disorder and a progressive cognitive impairment dating back about 6 months, showing a bilateral chronic subdural hematoma up to the convexity
CT scans of the brain of an 80-year-old man with a gait disorder and a progressive cognitive impairment dating back about 6 months, showing a bilateral chronic subdural hematoma up to the convexity
Citations
Expert Panel on Neurological Imaging; Shih RY, Burns J, Ajam AA, et al. ACR Appropriateness Criteria® head trauma: 2021 update. J Am Coll Radiol. 2021 May;18(5S):S13-36.[Abstract][Full Text]
American College of Surgeons. Best practice guidelines: the management of traumatic brain injury. 2024 [internet publication].[Full Text]
Carney N, Totten AM, O'Reilly C, et al. Guidelines for the management of severe traumatic brain injury, Fourth Edition. Neurosurgery. 2017 Jan 1;80(1):6-15.[Abstract][Full Text]
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