Subdural hematoma

Also known as a subdural hemorrhage (SDH), is a type of intracranial hematoma or spinal hematoma.

Blood gathers within the outermost meningeal layer, between the dura mater, which adheres to the skull, and the arachnoid mater, which envelops the brain. Usually resulting from tears in bridging veins that cross the subdural space, subdural hemorrhages may cause an increase in intracranial pressure (ICP), which can cause compression of and damage to delicate brain tissue.

Subdural hematoma classification.

Usually associated with traumatic brain injury (Traumatic subdural hematoma).

Those that arise in the setting of active Cerebrospinal fluid shunt:

Subdural hematoma after lumboperitoneal shunt.

Subdural hematoma after spine surgery.

Subdural hematoma and arachnoid cyst.

Spontaneous subdural hematoma.

see Subdural hematoma and anticoagulant therapy.

Endoscopic third ventriculostomy.

see Subdural hematoma after endoscopic third ventriculostomy

Subdural Hematoma as a Consequence of Epidural Anesthesia ¹⁾.

Leukemia and prostate cancer are the most common systemic cancers associated with subdural hematoma SDH, and gliomas may predispose to SDH more often than previously recognized ²⁾.

Sporadic reports of hemorrhage within the central nervous system in the setting of PV exist and are attributed to microvascular thrombotic events with hemorrhagic conversion. Though rare, spontaneous central nervous system hemorrhage in the absence of vascular malformation or an inciting event such as trauma can occur in the setting of myeloproliferative disorders like Polycythemia Vera ^{3) 4)}

Acute subdural hematoma treatment

Chronic subdural hematoma treatment

Posttraumatic epilepsy (PTS) are a serious complication in patients with SDH, particularly in acute subdural hematoma. The “prophylactic use” of antiepileptic drugs might be beneficial in patients with cumulative risk factors ⁵⁾.

The Department of Neurosurgery, Hospital Network Antwerp, Belgium published a case of severe bilateral subdural hematomas as a complication of diagnostic lumbar puncture for possible Alzheimer's disease ⁶⁾.

Infected subdural hematoma

116 SDH patients (18 acute, 56 mixed acute/subacute/chronic, 42 subacute/chronic) were included. At 3 months, 61 (53 %) patients had good outcomes (mRS 0-3) while 55 (47 %) were severely disabled or dead (mRS 4-6). Of those who underwent surgical evacuation, 54/94 (57 %) had good outcomes compared to 7/22 (32 %) who did not (p = 0.030). Patients with mixed acuity or subacute/chronic SDH had significantly better 3-month mRS with surgery (median mRS 1 versus 5 without surgery, p = 0.002) compared to those with only acute SDH (p = 0.494). In multivariable analysis, premorbid mRS, age, admission Glasgow Coma Score, history of smoking, and fever were independent predictors of poor 3-month outcome (all p < 0.05; area under the curve 0.90), while SDH evacuation tended to improve outcomes (adjusted OR 3.90, 95 % CI 0.96-18.9, p = 0.057).

Nearly 50 % of SDH patients were dead or moderate-severely disabled at 3 months. Older age, poor baseline, poor admission neurological status, history of smoking, and fever during hospitalization predicted poor outcomes, while surgical evacuation was associated with improved outcomes among those with mixed acuity or chronic/subacute SDH ⁷⁾.

63 subdural hematoma (18 acute, 13 subacute, and 32 chronic) patients admitted between 2012 and 2014 in the neurosurgery unit of Lomé University Hospital. Hematomas were classified according to the elapsed time after head injury and blood density on CT. The main parameter studied was the evolution of the Glasgow Coma Scale (GCS) in the 3 months following the trauma, enabling to establish an evolving profile of each type of hematoma. The average age of patients was 58.1 years for chronic subdural hematomas and 47.6 years for subacute subdural hematomas. Disease duration before admission was 13.1 days for chronic against 36.6 h for subacute hematoma. The clinical profile shows acute worsening within hours during the second week for patients with subacute hematoma, while it is progressive for patients with chronic hematoma. We noted two deaths, all victims of a subacute hematoma (one operated, one patient waiting for surgery). Iso-density hematoma on CT, especially in a young person, must be considered as a predictive factor of rapid neurological aggravation suggesting an urgent care or increased monitoring by paramedics ⁸⁾.