Diseases and Disorders

Subdural Hematoma

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DRG Category: 70

Mean LOS: 7.4 days

Description MEDICAL: Nonspecific Cerebrovascular Disorders with Major CC

DRG Category: 955

Mean LOS: 12.8 days

Description SURGICAL: Craniotomy for Multiple Significant Trauma

classification section:

Subdural hematoma (SDH) is an accumulating mass of blood, usually clotted, or a swelling that is confined to the space between the dura mater and the subarachnoid membrane. SDHs are space-occupying lesions and thus categorized as focal brain injuries, which account for approximately 50% of all head injuries and 60% of the mortality in head-injured patients. Sometimes an SDH is referred to as a mass lesion because it occupies critical space in the cranial vault. Deaths from SDH usually occur because of the expanding mass lesion that leads to excessive brain swelling and herniation, causing brain stem ischemia and hemorrhage.

SDHs are classified as either acute or chronic on the basis of when symptoms appear. Clinical findings in acute SDHs are evident within 24 to 72 hours after the traumatic event. A subacute SDH produces symptoms within 2 to 10 days; symptoms appear in chronic SDH within weeks or months (Table 5). Generally, head trauma involves both a primary injury and a secondary injury. The primary injury results from the initial impact, which causes immediate neurological damage and dysfunction. The secondary injury follows the initial trauma and probably stems from cerebral hypoxia and ischemia that then lead to cerebral edema, increased intracranial pressure (ICP), and brain herniation. A consequence of increased ICP, brain herniation is a life-threatening condition in which brain structures protrude through an opening in the brain cavity.

Types of Subdural Hematomas

AcuteUsually results from brain laceration with injury to the small pial veins bridging the subdural space24–72 hrDecreased level of consciousness, hemiparesis, unilateral pupil dilation, extraocular eye movement, paralysis, cranial nerve dysfunction
Subacute chronicSimilar to acute2–10 daysSimilar to acute
ChronicUsually occurs in the elderly or in problem drinkers who experience atrophy of the brain; often associated with falls2 wk or moreInterval when patient appears to recover and then progressive deterioration occurs; drowsiness, inattention, personality changes, headache; progresses to hemiparesis, pupil changes, decreased mental status
