Subdural hematoma [Neurosurgery Wiki]

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====== Subdural hematoma ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1jsI3JGQCWWHHeGD4cZOY0CiAdIR73OUgM9DJxvxwvyDehiEcu/?limit=15&utm_campaign=pubmed-2&fc=20240212061930}}

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. 

===== Classification =====

[[Subdural hematoma classification]].

===== Etiology =====

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]]
((Bishop TM, Elsayed KS, Kane KE. Subdural Hematoma as a Consequence of Epidural
Anesthesia. Case Rep Emerg Med. 2015;2015:597942. doi: 10.1155/2015/597942. Epub 
2015 Nov 30. PubMed PMID: 26697237; PubMed Central PMCID: PMC4677186.
)).

[[Leukemia]] and [[prostate cancer]] are the most common systemic [[cancer]]s associated with [[subdural hematoma]] SDH, and gliomas may predispose to SDH more often than previously recognized
((Reichman J, Singer S, Navi B, Reiner A, Panageas K, Gutin PH, Deangelis LM.
Subdural hematoma in patients with cancer. Neurosurgery. 2012 Jul;71(1):74-9.
doi: 10.1227/NEU.0b013e3182517938. PubMed PMID: 22705720.
)).

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]]
((Entezami P, Raval MP, Sanders LN, Adepoju A, Yamamoto J. Spontaneous Subdural
Hematoma in Patient with Polycythemia Vera. World Neurosurg. 2019
May;125:354-356. doi: 10.1016/j.wneu.2019.01.258. Epub 2019 Feb 16. PMID:
30780039.))
((Rana I, Tripathy LN, Basu S. Polycythemia Vera Presenting as Subdural
Hematoma. Neurol India. 2022 Jul-Aug;70(4):1717-1719. doi:
10.4103/0028-3886.355135. PMID: 36076704.))




===== Treatment =====

[[Acute subdural hematoma treatment]]

[[Chronic subdural hematoma treatment]]


===== Complications =====
[[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
((Won SY, Konczalla J, Dubinski D, Cattani A, Cuca C, Seifert V, Rosenow F,
Strzelczyk A, Freiman TM. A systematic review of epileptic seizures in adults
with subdural haematomas. Seizure. 2016 Nov 25;45:28-35. doi:
10.1016/j.seizure.2016.11.017. [Epub ahead of print] Review. PubMed PMID:
27914224.
)).

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
((Verslegers L, Schotsmans K, Montagna M, Feyen B, De Jong L, Crols R,
Engelborghs S. Severe bilateral subdural hematomas as a complication of
diagnostic lumbar puncture for possible Alzheimer's disease. Clin Neurol
Neurosurg. 2016 Dec 8;152:95-96. doi: 10.1016/j.clineuro.2016.12.003. [Epub ahead
of print] PubMed PMID: 27978461.
)).

[[Infected subdural hematoma]]
====Case series====
===2017===
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
((Weimer JM, Gordon E, Frontera JA. Predictors of Functional Outcome After
Subdural Hematoma: A Prospective Study. Neurocrit Care. 2017 Feb;26(1):70-79.
doi: 10.1007/s12028-016-0279-1. PubMed PMID: 27230968.
)).
===2016===
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 hematoma]]s and 47.6 years for [[subacute subdural hematoma]]s. 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
((Kpelao E, Beketi KA, Moumouni AK, Doleagbenou A, Ntimon B, Egbohou P, Mouzou
T, Tomta K, Sama DH, Abalo A, Walla A, Dossim A. Clinical profile of subdural
hematomas: dangerousness of subdural subacute hematoma. Neurosurg Rev. 2016
Apr;39(2):237-40. doi: 10.1007/s10143-015-0669-4. Epub 2015 Sep 18. PubMed PMID: 
26382645.
)).