Ver el código de «Subdural hemorrhage»

==Background==
[[File:Meninges-en.svg|thumb|Anatomy of the meninges]]
*Can present as acute (<14 days) and chronic (>14 days)
*Both types are caused by sudden acceleration-deceleration of the brain with resultant shearing of the bridging veins.
**Blood pools between the dura mater and arachnoid
*Patients with extreme atrophy are at increased risk (elderly, alcoholics)
**Patients less than 2 years old are also at increased risk
*SDH are often associated with other [[TBI|brain injuries]]

==Clinical Features==
*Patients with acute SDH generally will present unconscious after a severe [[head trauma|trauma]]
*Patients with chronic SDH generally present with [[altered mental status]] or vague complaints
*High index of suspicion warranted in the aforementioned groups of patients at increased risk with any history of head trauma regardless of severity

==Differential Diagnosis==
{{Intracranial hemorrhage DDX}}

==Evaluation==
[[File:Subduralandherniation.png|thumb|Large left-sided frontal-parietal subdural hematoma with associated midline shift.]]
{{Head trauma workup}}
*Noncontrast [[head CT|CT]] brain is the gold standard
**Acute SDH will show as a hyperdense (white) collection with a crescent-shaped appearance
**Chronic SDH will show as a hypodense (dark grey/black) collection in a crescent-shape
**Contrasted studies are useful in distinguishing acute, subacute, and chronic

==Management==
*See [[Head trauma (main)]]
*Emergent neurosurgical evacuation
**Operative intervention generally for patients with focal findings, >10mm hematoma, midline shift > 5mm, signs of increased intracranial pressure (ICP)<ref>Bullock MR, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006; 58(3):S16-24</ref> <ref>Evans JA, et al. A simple tool to identify elderly patients with a surgically important acute subdural haematoma. Injury. 2015 Jan;46(91):76-9</ref>
*Management of [[elevated ICP|ICP]]
**Head of bed to 30 degrees
**Short-term use of hyperventilation 
**Hyperosmolar agents ([[Mannitol]], [[hypertonic saline|3% saline]])
*[[Anticoagulant reversal|Reversal of anticoagulation]]
*Treat and prevent hypotension and hypoxia
**Associated with significantly increased mortality<ref>Chesnut, R.M., Marshall, L.F., Klauber, M.R., Blunt, B.A., Baldwin, N., Eisenberg, H.M., Jane, J.A., Marmarou, A. and Foulkes, M.A. (1993) ‘THE ROLE OF SECONDARY BRAIN INJURY IN DETERMINING OUTCOME FROM SEVERE HEAD INJURY’, The Journal of Trauma: Injury, Infection, and Critical Care, 34(2), pp. 216–222.</ref>
*Emergency Department [[Burr hole]], if indicated

==Disposition==
*Admission to neurosurgery or trauma surgery

==See Also==
*[[Intracranial Hemorrhage (Main)]]
*[[Head Trauma]]

==External Links==
*[http://radiopaedia.org/articles/subdural-haemorrhage SDH Radiographs]

==References==
<references/>

[[Category:Trauma]]
[[Category:Neurology]]