Complications
Various neurological deficits may result from the haematoma or its sequelae, including increased intracranial pressure. Recovery is of variable degree and time course.[3]
Coma can result from the head injury itself or from treatment of subdural haematoma (SDH).[3]
Large-volume SDHs with significant midline shift or brain swelling after their removal may result in direct compression of anterior and posterior cerebral arteries, causing ischaemia and/or infarction. SDHs that occur in association with significant subarachnoid haemorrhage may result in stroke from vasospasm. An increased risk of ischaemic stroke, in the 4 weeks after non-traumatic SDH, may be due to interruption of antithrombotic therapy after SDH diagnosis.[141]
Infection rates have been quoted to be 1% to 2%.[146]
There is a high risk of associated post-traumatic epilepsy.[147] Up to 24% of patients with traumatic SDHs develop clinical seizures or epileptiform changes on electroencephalography either on presentation or post-operatively.[148] If the patient has seizures within the first week and has a severe brain injury, the likelihood is higher that they will have seizures beyond the first week. It is recommended that the patient continue receiving phenytoin for at least 7 days after injury.[109][149][150]
Occurrence of seizures after this time frame may necessitate further antiepileptic treatment and/or consultation with a neurologist.
Blood can re-accumulate in the subdural space acutely after an evacuation procedure or may appear in a delayed fashion, presenting as a subacute or chronic SDH.
Meticulous attention must be paid to correcting any pre-existing or post-operative coagulopathy.[151] Frontal drainage after burr hole craniotomy has been shown to reduce risk of recurrence without increasing the risk of infection.[152]
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