Presentation
The classic presentation of an epidural hematoma is a loss of consciousness after the injury, followed by a lucid interval then neurologic deterioration. This classic presentation only occurs in less than 20% of patients. [ncbi.nlm.nih.gov]
Presentation varies widely in acute subdural hematoma (see Clinical). Many of these patients are comatose on admission. [emedicine.medscape.com]
Cephalalgia 26: 1245–6 Article CAS PubMed Google Scholar Williams EC, Buchbinder BR, Ahmed S, et al (2014) Spontaneous intracranial hypotension: presentation, diagnosis, and treatment. [link.springer.com]
These tests create images of the interior of the skull, usually detecting any subdural hematoma present. MRI is slightly superior to CT in detecting subdural hematoma, but CT is faster and more readily available. [webmd.com]
Entire Body System
- Epilepsy
[…] trauma (may be relatively mild, eg, in older individuals with cerebral atrophy) Acute subdural hematoma, with or without surgical intervention Spontaneous or idiopathic Risk factors for chronic subdural hematoma include the following: Chronic alcoholism Epilepsy [emedicine.medscape.com]
Cardiovascular
- Hypotension
Hypotension intracrânienne et hématome sous-dural subaigu. Ann. Fr. Med. [link.springer.com]
[…] indicators for acute subdural hematoma have been reported to include the following [16, 17, 15] : Low Glasgow coma scale motor score on admission (< 5) Pupillary abnormalities Alcohol use Injury by motorcycle accident Ischemic damage [18] Hypoxia or hypotension [emedicine.medscape.com]
Musculoskeletal
- Contusion
An acute subdural hematoma due to a ruptured cortical artery may be associated with only minor head injury, possibly without an associated cerebral contusion. [emedicine.medscape.com]
Neurologic
- Seizure
Seizures. You may have seizures, even if you’ve treated your hematoma. Subdural Hematoma Outlook Your health outlook after your subdural hematoma depends on how old you are, how severe your head injury was, and how quickly you got treatment. [webmd.com]
Medication: Drugs are used to control blood pressure, seizures or headaches. Catheter: A long, thin tube is threaded through blood vessels until it reaches the affected area. [aurorahealthcare.org]
Other symptoms include dizziness, nausea, vomiting, diplopia, seizures, loss of consciousness, or nuchal rigidity. [ncbi.nlm.nih.gov]
Most chronic subdural hematomas are probably caused by head injury; other causes and predisposing factors include coagulopathy, use of anticoagulants (including aspirin), seizure disorders, and CSF shunts. [11] Herniation syndromes In addition to increasing [emedicine.medscape.com]
- Intracranial Hemorrhage
Continuing Education Activity Intracranial hemorrhage encompasses four broad types of hemorrhage: epidural hemorrhage, subdural hemorrhage, subarachnoid hemorrhage, and intraparenchymal hemorrhage. [ncbi.nlm.nih.gov]
What Is a Subdural Hemorrhage? A subdural hemorrhage, also called a subdural hematoma, is a kind of intracranial hemorrhage, which is the bleeding in the area between the brain and the skull. [rwjbh.org]
The Efficacy of Factor VIIa in Emergency Department Patients With Warfarin Use and Traumatic Intracranial Hemorrhage. Acad Emerg Med. Mar 2010;17(3):244-251: Itshayek E, Rosenthal G, Fraifeld S, Perez-Sanchez X, Cohen JE, Spektor S. [emedicine.medscape.com]
- Focal Neurological Deficit
A physical exam may demonstrate a focal motor deficit, neurologic deficits, lethargy, or altered consciousness. [ncbi.nlm.nih.gov]
- Vertigo
Intraparenchymal Hemorrhage Non-traumatic intraparenchymal hemorrhages typically present with a history of sudden onset of stroke symptoms including a headache, nausea, vomiting, focal neurologic deficits, lethargy, weakness, slurred speech, syncope, vertigo [ncbi.nlm.nih.gov]
Workup
Common workup includes either a CT angiogram (CTA) of the head and neck, magnetic resonance angiography (MRA) of the head and neck, or diagnostic cerebral angiogram of the head and neck done emergently to look for an aneurysm, AVM, or another source of [ncbi.nlm.nih.gov]
Treatment
Treatment options Treatment for subdural hemorrhages depends on the severity of the condition. For minor hemorrhaging, observation may be the only treatment necessary. Surgery may be required for more severe situations. [aurorahealthcare.org]
Subdural Hematoma Treatment Treatment of subdural hematomas depends on their severity. Treatment can range from watchful waiting to brain surgery. [webmd.com]
Treatment varies depending on the etiology of the hemorrhage but can include treatment of an aneurysm or arteriovenous malformation or other etiology. [ncbi.nlm.nih.gov]
A subdural hemorrhage is an emergency that requires immediate treatment. Our team of board-certified neurosurgeons can treat subdural hemorrhage and other types of brain injury. [rwjbh.org]
When to seek medical advice You should always seek emergency medical treatment after a severe head injury. Go to your nearest A&E department or call 999. [nhs.uk]
Prognosis
Each type of hemorrhage results from different etiologies and the clinical findings, prognosis, and outcomes are variable. [ncbi.nlm.nih.gov]
Findings on CT scan or MRI may help indicate prognosis. [emedicine.medscape.com]
Your prognosis is best if your subdural hematomas are chronic, you deal with few symptoms, and you didn’t lose consciousness after your head injury. Older adults are at the highest risk of another brain bleed after a subdural hematoma. [webmd.com]
Etiology
Treatment varies depending on the etiology of the hemorrhage but can include treatment of an aneurysm or arteriovenous malformation or other etiology. [ncbi.nlm.nih.gov]
Subdural hematoma may also be spontaneous or caused by a procedure, such as a lumbar puncture (see Etiology). Rates of mortality and morbidity can be high, even with the best medical and neurosurgical care (see Prognosis). [emedicine.medscape.com]
Epidemiology
Epidemiology and Clinical Manifestations of Immune Thrombocytopenia. Hamostaseologie. 2019 Aug;39(3):238-249. [PubMed: 30868551] 2. [ncbi.nlm.nih.gov]
Epidemiology of chronic subdural haematoma. Acta Neurochir (Wien). 1975. 32(3-4):247-50. [QxMD MEDLINE Link]. Mashour GA, Schwamm LH, Leffert L. [emedicine.medscape.com]
Pathophysiology
Increased ICP may also decrease cerebral flood flow, possibly causing ischemia and edema; this further increases the ICP, causing a vicious circle of pathophysiologic events. [emedicine.medscape.com]
Pathophysiology Epidural Hematoma Epidural hematomas occur when blood dissects into the potential space between the dura and inner table of the skull. Most commonly this occurs after a skull fracture (85% to 95% of cases). [ncbi.nlm.nih.gov]
Prevention
Prevention The best way to prevent subdural hemorrhage is by avoiding head injury. [rwjbh.org]
Subependymal hemorrhage following drainage of chronic subdural hematoma: Probable causative mechanisms and prevention strategies. J Neurosci Rural Pract. 2015; 6(2):252. Doi: 10.4103/0976-3147.150303 Kalfas IH, Little JR. [medigraphic.com]
Smaller and non-operable hemorrhages may be managed medically with control of blood pressure, the reversal of anticoagulation or antiplatelet agents, and neuroprotective strategies to prevent and/or mitigate secondary cerebral injury. [ncbi.nlm.nih.gov]