Kotwica Z, Brzezinski J. Acute subdural haematoma in adults: an analysis of outcome in comatose patients. Acta Neurochir (Wien). 1993. 121(3-4):95-9. [QxMD MEDLINE Link].
Morinaga K, Matsumoto Y, Hayashi S, Omiya N, Mikami J, Sato H, et al. [Subacute subdural hematoma: findings in CT, MRI and operations and review of onset mechanism]. No Shinkei Geka. 1995 Mar. 23(3):213-6. [QxMD MEDLINE Link].
Matsuyama T, Shimomura T, Okumura Y, Sakaki T. Rapid resolution of symptomatic acute subdural hematoma: case report. Surg Neurol. 1997 Aug. 48(2):193-6. [QxMD MEDLINE Link].
Gennarelli TA, Thibault LE. Biomechanics of acute subdural hematoma. J Trauma. 1982 Aug. 22(8):680-6. [QxMD MEDLINE Link].
Hlatky R, Valadka AB, Goodman JC, Robertson CS. Evolution of brain tissue injury after evacuation of acute traumatic subdural hematomas. Neurosurgery. Jul 2007. 61(1 suppl):249-254. [QxMD MEDLINE Link].
Schroder ML, Muizelaar JP, Kuta AJ. Documented reversal of global ischemia immediately after removal of an acute subdural hematoma. Report of two cases. J Neurosurg. 1994 Feb. 80(2):324-7. [QxMD MEDLINE Link].
Atkinson JL, Lane JI, Aksamit AJ. MRI depiction of chronic intradural (subdural) hematoma in evolution. J Magn Reson Imaging. 2003 Apr. 17(4):484-6. [QxMD MEDLINE Link].
Kawakami Y, Chikama M, Tamiya T, Shimamura Y. Coagulation and fibrinolysis in chronic subdural hematoma. Neurosurgery. 1989 Jul. 25(1):25-9. [QxMD MEDLINE Link].
Katano H, Kamiya K, Mase M, Tanikawa M, Yamada K. Tissue plasminogen activator in chronic subdural hematomas as a predictor of recurrence. J Neurosurg. 2006 Jan. 104(1):79-84. [QxMD MEDLINE Link].
Tanaka A, Yoshinaga S, Kimura M. Xenon-enhanced computed tomographic measurement of cerebral blood flow in patients with chronic subdural hematomas. Neurosurgery. 1990 Oct. 27(4):554-61. [QxMD MEDLINE Link].
Foelholm R, Waltimo O. Epidemiology of chronic subdural haematoma. Acta Neurochir (Wien). 1975. 32(3-4):247-50. [QxMD MEDLINE Link].
Mashour GA, Schwamm LH, Leffert L. Intracranial subdural hematomas and cerebral herniation after labor epidural with no evidence of dural puncture. Anesthesiology. 2006 Mar. 104(3):610-2. [QxMD MEDLINE Link].
Cohen M, Scheimberg I. Subdural haemorrhage and child maltreatment. Lancet. 2009 Apr 4. 373(9670):1173; author reply 1173-4. [QxMD MEDLINE Link].
Servadei F. Prognostic factors in severely head injured adult patients with acute subdural haematoma's. Acta Neurochir (Wien). 1997. 139(4):279-85. [QxMD MEDLINE Link].
Servadei F, Nasi MT, Giuliani G, Cremonini AM, Cenni P, Zappi D, et al. CT prognostic factors in acute subdural haematomas: the value of the 'worst' CT scan. Br J Neurosurg. 2000 Apr. 14(2):110-6. [QxMD MEDLINE Link].
Wilberger JE Jr, Harris M, Diamond DL. Acute subdural hematoma: morbidity and mortality related to timing of operative intervention. J Trauma. 1990 Jun. 30(6):733-6. [QxMD MEDLINE Link].
Massaro F, Lanotte M, Faccani G, Triolo C. One hundred and twenty-seven cases of acute subdural haematoma operated on. Correlation between CT scan findings and outcome. Acta Neurochir (Wien). 1996. 138(2):185-91. [QxMD MEDLINE Link].
Abe M, Udono H, Tabuchi K, Uchino A, Yoshikai T, Taki K. Analysis of ischemic brain damage in cases of acute subdural hematomas. Surg Neurol. 2003 Jun. 59(6):464-72; discussion 472. [QxMD MEDLINE Link].
Phuenpathom N, Choomuang M, Ratanalert S. Outcome and outcome prediction in acute subdural hematoma. Surg Neurol. 1993 Jul. 40(1):22-5. [QxMD MEDLINE Link].
Sakas DE, Bullock MR, Teasdale GM. One-year outcome following craniotomy for traumatic hematoma in patients with fixed dilated pupils. J Neurosurg. 1995 Jun. 82(6):961-5. [QxMD MEDLINE Link].
Seelig JM, Becker DP, Miller JD, et al. Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours. N Engl J Med. 1981 Jun 18. 304(25):1511-8. [QxMD MEDLINE Link].
Kapsalaki EZ, Machinis TG, Robinson JS 3rd, Newman B, Grigorian AA, Fountas KN. Spontaneous resolution of acute cranial subdural hematomas. Clin Neurol Neurosurg. Apr 2007. 109(3):287-291. [QxMD MEDLINE Link].
Mori K, Maeda M. Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo). 2001 Aug. 41(8):371-81. [QxMD MEDLINE Link].
Stanisic M, Lund-Johansen M, Mahesparan R. Treatment of chronic subdural hematoma by burr-hole craniostomy in adults: influence of some factors on postoperative recurrence. Acta Neurochir (Wien). 2005 Dec. 147(12):1249-56; discussion 1256-7. [QxMD MEDLINE Link].
Suman S, Meenakshisundaram S, Woodhouse P. Bilateral chronic subdural haematoma: a reversible cause of parkinsonism. J R Soc Med. 2006 Feb. 99(2):91-2. [QxMD MEDLINE Link]. [Full Text].
Giray S, Sarica FB, Sen O, Kizilkilic O. Parkinsonian syndrome associated with subacute subdural haematoma and its effective surgical treatment: a case report. Neurol Neurochir Pol. 2009 May-Jun. 43(3):289-92. [QxMD MEDLINE Link].
Alemdar M, Selekler HM, Efendi H. A non-traumatic interhemispheric subdural haematoma: presented with headache as the sole complaint. J Headache Pain. 2005 Feb. 6(1):48-50. [QxMD MEDLINE Link].
Bartels RH, Verhagen WI, Prick MJ, Dalman JE. Interhemispheric subdural hematoma in adults: case reports and a review of the literature. Neurosurgery. 1995 Jun. 36(6):1210-4. [QxMD MEDLINE Link].
Luxon LM, Harrison MJ. Chronic subdural haematoma. Q J Med. 1979 Jan. 48(189):43-53. [QxMD MEDLINE Link].
Stein SC, Young GS, Talucci RC, et al. Delayed brain injury after head trauma: significance of coagulopathy. Neurosurgery. 1992 Feb. 30(2):160-5. [QxMD MEDLINE Link].
Wilms G, Marchal G, Geusens E, Raaijmakers C, Van Calenbergh F, Goffin J, et al. Isodense subdural haematomas on CT:MRI findings. Neuroradiology. 1992. 34(6):497-9. [QxMD MEDLINE Link].
Gentry LR, Godersky JC, Thompson B, Dunn VD. Prospective comparative study of intermediate-field MR and CT in the evaluation of closed head trauma. AJR Am J Roentgenol. 1988 Mar. 150(3):673-82. [QxMD MEDLINE Link].
Brain Trauma Foundation, AANS, Joint Section of Neurotrauma and Critical Care. Guidelines for the management of severe head injury. J Neurotrauma. 1996 Nov. 13(11):641-734. [QxMD MEDLINE Link].
Wong CW. Criteria for conservative treatment of supratentorial acute subdural haematomas. Acta Neurochir (Wien). 1995. 135(1-2):38-43. [QxMD MEDLINE Link].
Toutant SM, Klauber MR, Marshall LF, et al. Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury. J Neurosurg. 1984 Oct. 61(4):691-4. [QxMD MEDLINE Link].
Ducruet AF, Grobelny BT, Zacharia BE, et al. The surgical management of chronic subdural hematoma. Neurosurg Rev. 2012 Apr. 35(2):155-69; discussion 169. [QxMD MEDLINE Link].
Lega BC, Danish SF, Malhotra NR, Sonnad SS, Stein SC. Choosing the best operation for chronic subdural hematoma: a decision analysis. J Neurosurg. 2010 Sep. 113(3):615-21. [QxMD MEDLINE Link].
Chesnut RM, Marshall LF, Klauber MR, et al. The role of secondary brain injury in determining outcome from severe head injury. J Trauma. 1993 Feb. 34(2):216-22. [QxMD MEDLINE Link].
Nishijima DK, Dager WE, Schrot RJ, Holmes JF. The Efficacy of Factor VIIa in Emergency Department Patients With Warfarin Use and Traumatic Intracranial Hemorrhage. Acad Emerg Med. Mar 2010;17(3):244-251:
Itshayek E, Rosenthal G, Fraifeld S, Perez-Sanchez X, Cohen JE, Spektor S. Delayed posttraumatic acute subdural hematoma in elderly patients on anticoagulation. Neurosurgery. May 2006. 58(5):E851-856. [QxMD MEDLINE Link].
Narita E, Maruya J, Nishimaki K, Heianna J, Miyauchi T, Nakahata J, et al. [Case of infected subdural hematoma diagnosed by diffusion-weighted imaging]. Brain Nerve. 2009 Mar. 61(3):319-23. [QxMD MEDLINE Link].
Stroobandt G, Fransen P, Thauvoy C, Menard E. Pathogenetic factors in chronic subdural haematoma and causes of recurrence after drainage. Acta Neurochir (Wien). 1995. 137(1-2):6-14. [QxMD MEDLINE Link].

Media Gallery

Acute right-sided subdural hematoma associated with significant midline shift (ie, subfalcine herniation) shown on CT scan.
Bilateral chronic subdural hematomas shown on CT scan. Midline shift is absent because of bilateral mass effect. Subdural hematoma is bilateral in 20% of patients with chronic subdural hematoma.
An acute subdural hematoma is shown in this intraoperative photograph. Note the frontotemporoparietal flap used. The hematoma is currant jelly–like in appearance.
A left-sided acute subdural hematoma (SDH). Note the high signal density of acute blood and the (mild) midline shift of the ventricles.
A left-sided chronic subdural hematoma (SDH). Note the effacement of the left lateral ventricle.
Chronic subdural hematomas (SDHs) are commonly bilateral and have areas of acute bleeding, which result in heterogeneous densities. Note the lack of midline shift due to the presence of bilateral hematomas.
An isodense subdural hematoma (SDH). Note that no sulcal markings are below the inner table of the skull on the right side. This hematoma has scattered areas of hyperdense, or acute, blood within it.
Isodense subdural hematoma (SDH) as pictured with MRI. MRI can more readily reveal smaller SDHs, and, on MRI, the imaging of the blood products change characteristically over time.
Atrophy of the brain, resulting in a space between the brain surface and the skull, increases the risk of subdural hematoma (SDH).
An acute subdural hematoma (SDH) as a complication of a craniotomy. Note the significant mass effect with midline shift.
Acute subdural hematoma. Note the bright (white) image properties of the blood on this noncontrast cranial CT scan. Note also the midline shift. Image courtesy of J. Stephen Huff, MD
Subacute subdural hematoma. The crescent-shaped clot is less white than on CT scan of acute subdural hematoma. In spite of the large clot volume, this patient was awake and ambulatory. Image courtesy of J. Stephen Huff, MD.

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Author

Richard J Meagher, MD Attending Neurosurgeon, The Spine Institute of Southern NJ

Richard J Meagher, MD is a member of the following medical societies: American Association of Neurological Surgeons, North American Spine Society, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

William F Young, MD Attending Neurosurgeon, Fort Wayne Neurological Center

William F Young, MD is a member of the following medical societies: Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD Professor and Vice Chair, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, OHSU Stroke Center

Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology, American Stroke Association

Disclosure: Medscape Neurology Editorial Advisory Board for: Stroke Adjudication Committee, CREST2; Physician Advisory Board for Coherex Medical; National Leader and Steering Committee Clinical Trial, Bristol Myers Squibb; Abbott Laboratories, advisory group.

Acknowledgements

Howard S Kirshner, MD Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center

Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association

Disclosure: Nothing to disclose.

Norman C Reynolds Jr, MD Neurologist, Veterans Affairs Medical Center of Milwaukee; Clinical Professor, Medical College of Wisconsin

Norman C Reynolds Jr, MD is a member of the following medical societies: American Academy of Neurology, Association of Military Surgeons of the US, Movement Disorders Society, Sigma Xi, and Society for Neuroscience

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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