Acute Subdural Hematoma

Subdural hematoma can be due to either an acute or a chronic event. In acute subdural hematoma, a brief lucid interval occurs between the head trauma and the patient becoming comatose, although the patient is usually comatose from the time of trauma. The bleed may be unilateral or bilateral and is often accompanied by lacerations of the scalp and contusions to the brain and parenchyma. A CT scan will confirm the diagnosis in up to 90% of cases, although angiography may be necessary. Neurosurgical intervention is required.

Chronic subdural hematoma is usually precipitated by minor head injury, which is often forgotten by the patient, and the trauma may have occurred several months previously. This form of hematoma occurs more commonly in the elderly and in patients receiving anticoagulant therapy. In addition to the headache, the patient may have decreased mentation, confusion, and drowsiness. The headache is considered secondary to the stretching of the tributary veins that drain the vessels of the cerebral hemispheres into the sagittal sinuses. Neuroimaging will establish the diagnosis, although angiography may be required. Treatment consists of surgical burr holes and evacuation of the clot.

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