Subdural and Epidural Hematoma

Epidural and subdural hematomas (EDH and SDH) manifesting shortly after acute head trauma generally, although not always, lead to neurologic deficits. These entities (commonly SDH) can also present some time after the traumatic event, especially in the elderly, in whom headache may be the only finding.

Causes

Subdural hematomas are most often caused by head injury, when rapidly changing velocities within the skull may stretch and tear small bridging veins. Subdural hematomas due to head injury are described as traumatic. Much more common than epidural hemorrhages, subdural hemorrhages generally result from shearing injuries due to rotational or linear forces

Symptoms

• Decreased level of consciousness (LOC) following head injury
• Headache (common in conscious and chronic SDH patients).
• Seizures ++
• Focal neurologic symptoms
• Confusion, personality changes (chronic SDH)

Signs

• Diminished LOC including coma
• Focal neurologic signs including dilated pupil and hemiparesis. Classically the dilated pupil is ipsilateral to the hematoma and the hemiparesis is contralateral; however, the pupil may be contralaterally dilated ++, and the hemiparesis can be ipsilateral ++. This is caused by either direct injury of the third nerve or midbrain or by compression of the contralateral cerebral peduncle. (Patients with dilated pupils from this mechanism have severely diminished LOC; anisocoria in a conscious patient nearly always represents local eye injury or installation of mydriatic drops.)
• May have normal examination or subtle deficits

Treatment

Treating hematomas mainly requires surgery. If the blood is localized and isn't clotting excessively, your doctor may create a hole through your skull (perforation) and then remove the liquid by suction. Large hematomas may require that a section of your skull be opened (craniotomy) to remove the blood. Some subdural hematomas don't need to be removed because they're small and produce no signs or symptoms.

Doctors may use medications, such as corticosteroids and diuretics, to control brain swelling (edema) after a head injury.