Subdural Haematoma

Accumulation of blood in the subdural space following rupture of a vein

Aetiology

  • Usually due to trauma causing damage to one of the bridging veins

Clinical presentation

  • The interval between injury and symptoms can be days, or may extend to weeks or months
  • Headache
  • Drowsiness
  • Confusion
  • Focal deficits, such as hemiparesis or sensory loss, develop
  • Epilepsy occasionally occurs
  • Stupor, coma and coning may follow

Investigations

  • Urgent CT brain - classically shows a crescent of blood around the brain tissue, and midline shift
  • If absent, and still suspicious, do LP to confirm - will be blood in CSF
  • MRI more sensitive for small haematomas
notion image

Management

  • Close neurosurgical monitoring
  • Even large collections can resolve spontaneously without drainage