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Management of Subdural Hematomas: Part I. Medical Management of Subdural Hematomas

  • Critical Care Neurology (K Sheth, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

Subdural hematomas (SDH) represent common neurosurgical problem associated with significant morbidity, mortality, and high recurrence rates. SDH incidence increases with age; numbers of patients affected by SDH continue to rise with our aging population and increasing number of people taking antiplatelet agents or anticoagulation. Medical and surgical SDH management remains a subject of investigation.

Recent findings

Initial management of patients with concern for altered mental status with or without trauma starts with Emergency Neurological Life Support (ENLS) guidelines, with a focus on maintaining ICP < 22 mmHg, CPP > 60 mmHg, MAP 80–110 mmHg, and PaO2 > 60 mmHg, followed by rapid sequence intubation if necessary, and expedited acquisition of imaging to identify a space-occupying lesion. Patients are administered anti-seizure medications, and their antiplatelet medications or anticoagulation may be reversed if neurosurgical interventions are anticipated, or until hemorrhage is stabilized on imaging.

Summary

Medical SDH care focuses on (a) management of intracranial hypertension; (b) maintenance of adequate cerebral perfusion; (c) seizure prevention and treatment; (d) maintenance of normothermia, eucarbia, euglycemia, and euvolemia; and (e) early initiation of enteral feeding, mobilization, and physical therapy. Post-operatively, SDH patients require ICU level care and are co-managed by neurointensivists with expertise in treating increased intracranial pressure, seizures, and status epilepticus, as well as medical complications of critical illness. Here, we review various aspects of medical management with a brief overview of pertinent literature and clinical trials for patients diagnosed with SDH.

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Acknowledgements

The editors would like to thank Dr. Myrna Rosenfeld for taking the time to review this manuscript. Elena I Fomchenko, Charles C Matouk, and Jason L Gerrard are supported by Yale Neurosurgery. Emily J Gilmore and Kevin N Sheth are supported by Yale Department of Clinical Neurosciences.

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Authors and Affiliations

  1. Department of Neurosurgery, Yale University, 20 York St, New Haven, CT, USA

    Elena I. Fomchenko MD, PhD, Charles C. Matouk MD & Jason L. Gerrard MD

  2. Department of Neurology, Yale University School of Medicine, New Haven, CT, USA

    Emily J. Gilmore MD & Kevin N. Sheth MD

  3. Division of Neuro-Critical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT, USA

    Emily J. Gilmore MD & Kevin N. Sheth MD

  4. Department of Clinical Neurosciences, Yale University, 20 York St, New Haven, CT, USA

    Kevin N. Sheth MD

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  2. Emily J. Gilmore MD
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  3. Charles C. Matouk MD
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  4. Jason L. Gerrard MD
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  5. Kevin N. Sheth MD
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Corresponding author

Correspondence to Elena I. Fomchenko MD, PhD.

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Conflict of Interest

Elena I Fomchenko, Emily J Gilmore, Charles C Matouk, and Jason L Gerrard, each declare no conflicts of interest.

Kevin N Sheth is a section editor for Current Treatment Options in Neurology.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Critical Care Neurology

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Fomchenko, E.I., Gilmore, E.J., Matouk, C.C. et al. Management of Subdural Hematomas: Part I. Medical Management of Subdural Hematomas. Curr Treat Options Neurol 20, 28 (2018). https://doi.org/10.1007/s11940-018-0517-2

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  • DOI: https://doi.org/10.1007/s11940-018-0517-2

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