From the Research
Follow-up CT scans for subdural hematomas should be performed at 24-48 hours after the initial scan to assess for expansion or stability, then again at 7-14 days to evaluate resolution or need for intervention, with the most recent study 1 suggesting that a systematic CT scan within the first two months after chronic subdural hematoma evacuation has a marginal impact on patient management.
Guidelines for Recording Follow-up CT Scans
The guidelines for recording follow-up CT scans in patients with subdural hematoma are as follows:
- For chronic subdural hematomas being managed conservatively, scans should be repeated at 4-6 weeks.
- More frequent imaging is warranted if the patient shows neurological deterioration, including new or worsening headache, altered mental status, focal deficits, or seizures.
- For patients on anticoagulants or antiplatelets, earlier follow-up imaging at 12-24 hours is recommended due to higher risk of expansion.
- After surgical evacuation, a CT scan should be obtained within 24 hours post-procedure, then at 4-6 weeks to confirm complete resolution, as suggested by 2.
Rationale for Follow-up CT Scans
The timing of these scans allows clinicians to monitor the natural evolution of subdural collections, which typically expand over the first few days, then gradually resolve over weeks to months.
- Imaging frequency can be reduced once stability is demonstrated, but complete radiographic resolution often lags behind clinical improvement, so clinical assessment should guide management decisions alongside imaging findings.
- The study by 1 found that the use of a delayed systematic CT scan after CSDH surgery has a marginal impact on patient management, and the indication for reoperation without symptoms seems highly subjective.
Special Considerations
- For patients with isolated falcotentorial subdural hematomas, repeat CT scans may not be necessary, as suggested by 3.
- The study by 4 found that routine postoperative CT-scans after burr hole trepanation for chronic subdural hematoma were not beneficial when performed with an indwelling drain, and recommends CT-scanning after drainage removal.