bubble_chart Overview

Acute subdural hematoma refers to a hematoma that occurs within 3 days after a head injury and is located in the space between the dura mater and the arachnoid membrane. Among subdural hematomas, the acute type has the highest incidence, accounting for approximately 70%. It often occurs secondary to severe cerebral contusion and laceration, especially contrecoup contusions. The source of bleeding is primarily from the contused and lacerated brain tissue, with a minority of cases caused by tearing of bridging veins near the venous sinuses. Early clinical manifestations are similar to those of cerebral contusion and laceration, with most patients presenting persistent unconsciousness after injury. The condition rapidly deteriorates due to hematoma expansion, often leading to early signs of increased intracranial pressure, brain compression, and herniation. Although timely surgical decompression can save some patients, the rates of disability and mortality remain very high. This is not only due to bleeding but also, more importantly, to severe multiple cerebral contusions and secondary cerebral edema.

bubble_chart Clinical Manifestations

1. Post-traumatic unconsciousness is more severe, with rare intermediate lucid intervals or periods of improvement, followed by a gradual deepening of unconsciousness.
2. Focal cerebral symptoms are more common, such as hemiplegia, aphasia, and focal epilepsy.
3. Projectile vomiting and agitation are more frequent, accompanied by slowed respiration and pulse, as well as elevated blood pressure.
4. Signs of brain herniation appear rapidly, especially in cases of acute subdural hematoma. Shortly after unilateral pupil dilation, bilateral pupil dilation occurs, accompanied by decerebrate rigidity and pathological breathing.

bubble_chart Diagnosis

1. There is a history of head injury, with severe unconsciousness after the injury, with or without a "lucid or improved interval."
2. There are signs of cerebral contusion and laceration, as well as progressive brain compression. Supratentorial hematomas often present with ipsilateral temporal lobe herniation syndrome. In the advanced stage, bilateral pupil dilation, decerebrate rigidity, and pathological breathing may occur.
3. In cases of supratentorial hematoma, cranial ultrasound may show midline shift, while cerebral angiography, head CT, or MRI can reveal the location and size of the hematoma.
4. Exploratory skull drilling reveals subdural hematoma.

bubble_chart Treatment Measures

1. Surgical treatment: removal of hematoma, hemostasis, and decompression.
2. Conservative treatment: used when the hematoma is small and clinical symptoms are stable, but close attention should be paid to changes in the condition.
3. Symptomatic treatment.

Most patients with acute subdural hematoma experience progressively deepening unconsciousness after head injury, with rapid deterioration of their condition, requiring urgent transfer to a hospital equipped for craniotomy. CT is the most diagnostically significant first-choice examination. Once the diagnosis is confirmed, emergency surgery is necessary, as even a few minutes' advance can be crucial for improving cure rates and the patient's quality of life. Hematomas often occur at the site of impact or the contrecoup site. In critical situations where time is insufficient for any examination, doctors can determine the drilling location based on the head impact point, injury mechanism, and neurological localization signs to perform hematoma evacuation and decompression, thereby gaining valuable treatment time.

bubble_chart Cure Criteria

1. Cure; hematoma disappears, symptoms and signs resolve, normal life and work are restored, may be left with a skull defect.
2. Improvement: hematoma disappears, symptoms improve, with residual neurological dysfunction, able to care for oneself or partially, retains some work capacity or loses partial labor ability.
3. No cure: hematoma does not completely disappear, symptoms and signs show no improvement, unable to care for oneself.