Brain (CNS)
Subdural Hematoma
경막하혈종
Bleeding between dura and arachnoid from torn bridging veins, usually traumatic
- How common
- 5-25% of TBI cases
- Typical age
- Elderly and infants
What is it?
Trauma tears bridging veins between cortex and dural sinuses → slow low-pressure venous bleed → chronic SDH develops membrane and rebleeds.
Commonly affected: Cerebral convexity (frontal/parietal)
How it develops
- Head traumaRotational acceleration/deceleration
- Bridging vein tearCortical to dural sinus veins
- Slow expansionOver hours to days
- Chronic membraneNeovascularization and rebleeding
Symptoms
- HeadacheInsidious dull ache
- Altered mental statusMay mimic dementia
- Hemiparesis/aphasiaFrom cortical compression
- Gait instabilityIncreased fall risk
- SeizureCortical irritation
How it is examined
- GCSTrack LOC changes
- Pupil/brainstem examLook for herniation
- Anticoagulant historyCheck warfarin/DOAC/antiplatelets
Imaging
Non-contrast head CT.
- Crescent-shaped collection
- Crosses suture lines
- Acute: hyperdense / Chronic: hypodense
MRI useful for isodense or layered SDH.
- Subacute isodense SDH visible
- Membrane visualization
Non-surgical care
- Reverse anticoagulationWarfarin: vit K + 4F-PCC; DOAC: specific reversal
- ObservationFor <1 cm thickness, midline shift <5 mm
- ICP managementHead elevation, mannitol 0.5-1 g/kg
- Seizure prophylaxisLevetiracetam x 7 days
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Thickness >10 mm, midline shift >5 mm, GCS decline, focal deficits
Procedures that may be discussed
- Burr hole drainage (standard for chronic SDH)
- Craniotomy + evacuation (acute SDH)
- MMA embolization (prevent recurrence)
Outlook
Chronic SDH: >80% improve after burr hole. Acute SDH mortality 30-90% based on GCS/age.