ICH Subdural Hematoma

Posted On May 5, 2020

Bleeding into the space outside the brain under the dura.

  • Acute SDH – caused by tear of bridging veins, rarely from small cortical arterial bleed
  • Chronic SDH: form a hydroma
  • Acute on chronic SDH: from rebleed

Risk factors

  • Older age
  • alcohol abuse
  • previous traumatic brain injury
  • more often in male
  • use of antiplatelet, anticoagulant

Nonoperative Management for acute sdh

  • Steroid not helpful
  • Clot thickness < 10 mm
  • Midline shift < 5 mm
  • No sign of increased intracranial pressure

Surgical treatment may be needed for Acute SDH

  • Glasgow coma scale score decreased by 2 or more points from onset to admission
  • CT head: clot thickness > 10 mm, or midline shift > 5 mm
  • Neuro exam change: example: unequal pupil

Recurrent Acute SDH

  • usually rare
  • may be caused by an unerlying bleeding source: such as AvM, mets, or intrcranial hypotension

Recurrent chronic SDH

  • more frequent: around 5-30 percent
  • Risk factors: older age, thicker hematoma, bilateral presentation
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