Neurology

Subdural Hematoma song

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Subdural Hematoma

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Subdural hematoma results from tearing of bridging veins between the cortex and dural sinuses, causing venous blood to accumulate in the subdural space.
Classic presentation is an elderly patient or chronic alcoholic with brain atrophy (stretched bridging veins) who develops headache and altered consciousness after minor or no trauma.
Acute subdural hematoma appears hyperdense (white) on non-contrast CT and is associated with high-velocity trauma and significant underlying brain injury.
Chronic subdural hematoma appears hypodense (dark) on CT, develops over weeks, and classically presents with fluctuating confusion, headache, and focal neurologic deficits in the elderly.
The lucid interval — a brief period of normal consciousness followed by rapid deterioration — is more classically associated with epidural hematoma, helping distinguish it from subdural hematoma.
Infants with subdural hematomas, bilateral retinal hemorrhages, and no clear trauma history raise strong concern for non-accidental trauma (shaken baby syndrome).
Anticoagulant use (e.g., warfarin) and coagulopathies significantly increase subdural hematoma risk and worsen outcomes.
Subacute subdural hematoma (days 1–3 weeks) appears isodense to brain parenchyma on CT, making it easy to miss; MRI is preferred for detection in this phase.
Small or asymptomatic chronic subdural hematomas may be managed conservatively, while large, symptomatic, or expanding hematomas require surgical evacuation via burr hole craniotomy.
Midline shift on CT, rising ICP, and herniation signs (unilateral fixed dilated pupil, Cushing's triad) indicate a neurosurgical emergency requiring immediate intervention.