Subdural haematoma

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.

One week of prophylactic antiepileptic therapy (e.g., phenytoin, levetiracetam) should be considered in all cases of acute and acute-on-chronic SDH, according to the Brain Trauma Foundation guidelines.

Aggressive reversal of coagulopathy should be accomplished in most patients with SDH who are taking anticoagulants.

Surgical therapy is usually indicated for acute or chronic SDHs that are expansile or causing neurological deficit. Observation may be employed for small, stable SDHs that are not causing neurological compromise.

Control of raised intracranial pressure using head-of-bed elevation, analgesics, intubation with anaesthetics and sedation, hyperosmolar treatment, barbiturates, or decompressive hemicraniectomy may be required.

Treatment complications include early or delayed re-accumulation of SDH, seizures, vascular injury to cortical veins and arteries or dural sinuses adjacent to the haematoma, strokes, persistent neurological deficit, coma, and death.

SDH is a collection of blood between the dural and arachnoid coverings of the brain. As the volume of the haematoma increases, brain parenchyma is compressed and displaced, and the intracranial pressure may rise and cause herniation. 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).