From the Guidelines
A subdural hematoma typically presents with a range of clinical symptoms, including headache, confusion, and weakness, which can develop over hours to days, and its management depends on the size, symptoms, and presence of underlying conditions such as spinal CSF leak, as indicated in the multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension 1. The clinical presentations of a subdural hematoma can vary widely, including:
- Headache
- Confusion
- Drowsiness
- Speech changes
- Weakness or numbness, often on one side of the body
- Seizures
- Loss of consciousness or coma in severe cases Elderly patients may exhibit more subtle symptoms, such as gradual cognitive decline, personality changes, or gait disturbances that can mimic dementia 1. The management of subdural hematoma depends on its size and symptoms, with small or asymptomatic hematomas being managed conservatively, while symptomatic hematomas with significant mass effect may require burr hole drainage in conjunction with treating the underlying cause, such as a spinal CSF leak 1. It is essential to investigate the possibility of spinal CSF leak in patients with subdural hematoma, especially those with a high index of suspicion, such as supportive history of orthostatic headache, or absence of trauma/coagulopathy/alcohol misuse, using MRI of the brain with contrast and whole spine 1.
From the Research
Clinical Presentations of Subdural Hematoma
The clinical presentations of subdural hematoma can vary depending on the form and cause of the disease. Some common presentations include:
- Headache 2, 3, 4
- Confusion 2
- Ataxia 2
- Hemiparesis 2, 3
- Weakness in extremities 4
- Loss of consciousness 3
- Drowsiness 3
- Focal neurologic signs 2
- Unconsciousness 5
Forms of Subdural Hematoma
Subdural hematoma can present in different forms, including:
- Acute subdural hematoma (aSDH) 6, 3
- Subacute subdural hematoma 6
- Chronic subdural hematoma (CSDH) 6, 5
- Bilateral isodense CSDH 5
- Multiple loculations 5
- Intrahematoma membranes 5
- Fresh bleeding 5
- Hemolysis 5
Diagnosis and Management
Diagnosis of subdural hematoma is usually made by:
- Contrast-enhanced computed tomography (CT) scan 5, 4
- Magnetic resonance imaging (MRI) scan 5, 4 Management options include:
- Surgical intervention 2, 5, 3, 4
- Medical management 2
- Burr-hole evacuation 5
- Craniotomy 5
- Twist drill craniostomy 5
- Dural biopsy 5
- Nonsurgical management 5
- Use of steroids and angiotensin converting enzyme inhibitors 5