====== Acute subdural hematoma treatment ======

Management steps include anticoagulation reversal, seizure prevention, blood pressure management, and indications for intracranial pressure monitoring. 

Direct surgical management, includes open craniotomy, [[twist drill]], and [[burr hole]] [[drainage]] and the usage of subdural drainage systems
((Huang KT, Bi WL, Abd-El-Barr M, Yan SC, Tafel IJ, Dunn IF, Gormley WB. The
Neurocritical and Neurosurgical Care of Subdural Hematomas. Neurocrit Care. 2016 
Apr;24(2):294-307. doi: 10.1007/s12028-015-0194-x. PubMed PMID: 26399248.
)).

Possible implications of [[medical treatment]] in subdural hematomas in the [[developing country]]
((Del Castillo-Calcáneo J, García-González U, Rodriguez-Valencia F. Possible
implications of medical treatment in subdural hematomas in the developing world. 
World Neurosurg. 2018 Jun 23. pii: S1878-8750(18)31357-3. doi:
10.1016/j.wneu.2018.06.141. [Epub ahead of print] PubMed PMID: 29945012.
)).
----
Initial [[management]] of [[patient]]s with concern for altered mental status with or without trauma starts with Emergency Neurological Life Support (ENLS) guidelines, with a focus on maintaining [[ICP]] < 22 mmHg, [[CPP]] > 60 mmHg, [[MAP]] 80-110 mmHg, and [[PaO2]] > 60 mmHg, followed by rapid sequence [[intubation]] if necessary, and expedited acquisition of imaging to identify a space-occupying lesion. Patients are administered antiseizure medications, and their antiplatelet medications or anticoagulation may be reversed if neurosurgical interventions are anticipated, or until hemorrhage is stabilized on imaging. Medical SDH care focuses on (a) management of [[intracranial hypertension]]; (b) maintenance of adequate [[cerebral perfusion]]; (c) seizure prevention and treatment; (d) maintenance of normothermia, eucarbia, euglycemia, and euvolemia; and (e) early initiation of enteral feeding, mobilization, and physical therapy. Post-operatively, SDH patients require ICU level care and are co-managed by neurointensivists with expertise in treating increased intracranial pressure, seizures, and status epilepticus, as well as medical complications of critical illness
((Fomchenko EI, Gilmore EJ, Matouk CC, Gerrard JL, Sheth KN. Management of
Subdural Hematomas: Part I. Medical Management of Subdural Hematomas. Curr Treat 
Options Neurol. 2018 Jun 23;20(8):28. doi: 10.1007/s11940-018-0517-2. Review.
PubMed PMID: 29936548.
)).
----
van Essen et al determined whether surgery reduces mortality in traumatic ASDH compared with initial conservative treatment. A systematic search was performed in the databases [[IndexCAT]], PubMed, Embase, [[Web of Science]], Cochrane library, CENTRAL, Academic Search Premier, Google Scholar, ScienceDirect, and CINAHL for studies investigating ASDH treated conservatively and surgically, without restriction to publication date, describing the mortality. Cohort studies or trials with at least five patients with ASDH, clearly describing surgical, conservative treatment, or both, with the mortality at discharge, reported in English or Dutch, were eligible. The search yielded 2025 reports of which 282 were considered for full-text review. After the risk of bias assessment, we included 102 studies comprising 12,287 patients. The data were synthesized using a meta-analysis of absolute risks; this was conducted in random-effects models, with dramatic effect estimation in subgroups. Overall mortality in surgically treated ASDH is 48% (95% confidence interval [CI] 44-53%). Mortality after surgery for comatose patients (Glasgow Coma Scale ≤8) is 41% (95% CI 31-51%) in contemporary series (after 2000). Mortality after surgery for non-comatose ASDH is 12% (95% CI 4-23%). Conservative treatment is associated with an overall mortality of 35% (95% CI 22-48%) and 81% (95% CI 56-98%) when restricted to comatose patients. The absolute risk reduction is 40% (95% CI 35-45%), with a number needed to treat of 2.5 (95% CI 2.2-2.9) to prevent one death in comatose ASDH. Thus, surgery is effective to reduce mortality among comatose patients with ASDH. The magnitude of the effect is large, although the effect size may not be sufficient to overcome any bias
((van Essen TA, Res L, Schoones J, de Ruiter G, Dekkers O, Maas A, Peul W, van der Gaag NA. Mortality Reduction of Acute Surgery in Traumatic Acute Subdural Hematoma since the 19th Century: Systematic Review and Meta-Analysis with Dramatic Effect: Is Surgery the Obvious Parachute? J Neurotrauma. 2022 Aug 30. doi: 10.1089/neu.2022.0137. Epub ahead of print. PMID: 35699084.))



===== Conservative =====

[[Acute subdural hematoma conservative treatment]].



===== Acute subdural hematoma surgery =====

[[Acute subdural hematoma surgery]].