What Is a Subdural Hematoma?

Subdural hematoma refers to the accumulation of intracranial hemorrhagic blood in the subdural space, with the highest incidence of intracranial hematoma. According to the time of post-injury hematoma, it can be divided into acute subdural hematoma (within 3 days after injury), subacute subdural hematoma (within 3 days to 3 weeks after injury) and chronic subdural hematoma (3 days after injury). Weeks or more).

Basic Information

English name

subdural haematoma

Visiting department

neurosurgery

Multiple groups

Seniors and children

Common locations

Elderly forehead or occipital focus and bilateral chronic subdural hematoma in children

Common causes

Accelerated violence causes tearing of the bridge vein between the cortex and sinuses or cerebral contusion, bleeding caused by rupture of the cortical blood vessels

Common symptoms

Coma, hemiplegia, aphasia, headache, blurred vision, weakness of one limb, etc.

Causes of subdural hematoma

Acute and subacute subdural hematomas are usually caused by accelerated torture of the bridging veins between the cortex and sinuses or bleeding caused by rupture of the cerebral cortex due to cerebral contusion, and most often occur at the point of impact. The majority of chronic subdural hematomas have a history of mild head trauma, especially in the forehead or occipital area of the elderly. Chronic subdural hematoma in children is mostly bilateral, often caused by birth injuries.

Clinical manifestations of subdural hematoma

Acute subdural hematoma

The clinical symptoms are severe and rapidly worsen, especially the acute hematoma. Intermediate sobriety is rare and the coma gradually deepens. Symptoms of increased intracranial pressure appear earlier, symptoms of cerebral hernia appear faster, and focal symptoms such as hemiplegia and aphasia are more common.

2. Chronic subdural hematoma

The medical history is not clear, but there may be a history of minor trauma. Symptoms of chronic intracranial pressure increase often occur 1 to 3 months after the injury, such as headache, blurred vision, and weakness of one limb. Symptoms of mental intelligence include memory loss, mental retardation, and mental disorders. Focal symptoms include hemiplegia and aphasia.

Subdural hematoma examination

1. X-ray plain film inspection

Some patients with acute subdural hematoma are accompanied by skull fractures. Patients with chronic subdural hemorrhage may show cerebral trauma, sphenoid enlargement, and bone resorption.

2.Head CT scan

Acute subdural hematomas appear as crescent or semilunar high-density areas on the brain surface. In the chronic subdural hematoma, a crescent-shaped, semi-lunar-shaped mixed density or iso-density shadow can be seen under the skull inner plate, the midline shift, and the ventricle is compressed.

3. MRI scan of the head

Subacute or chronic subdural hematomas showed high signals at T1 and T2.

Diagnosis of subdural hematoma

Acute subdural hematoma can be clearly diagnosed based on a history of trauma, increased cranial hypertension, and focal signs, combined with a skull CT scan. Chronic subdural hematomas occur in the elderly and children. Chronic intracranial hypertension usually occurs 3 weeks to several months after the injury, and most of them can be confirmed by CT scan of the skull.

Subdural hematoma treatment

Acute subdural hematoma

Acute subdural hematoma with less bleeding volume, no progressive deterioration of consciousness, hematoma thickness <10mm, midline displacement <5mm, can be temporarily treated without surgery. Surgical treatments are performed with bone flap craniotomy and / or bone flap decompression.

2. Chronic subdural hematoma

Skull drilling and closed drainage is preferred. For hematoma cyst wall hypertrophy with calcification, a bone flap craniotomy is required to remove the hematoma.