Neuroimaging Cases 005

Subdural hematomas

Latest instalment in our neuroimaging series. Images, text and cases collated by Madison Watts MD, Rebecca DeCarlo MD, Faith Meyers MD and Steven Perry MD. First published on EMGuideWire.com and peer reviewed by Professor Michael Gibbs.

Cases reviewed

• Case 1: A 63-year-old female presents to the ED with increasing confusion noted by her neighbor. She had an unwitnessed fall yesterday.
• Case 2: A 68-year-old female with a history of diabetes found unresponsive on the bathroom floor.
• Case 3: A 77-year-old, independently functional male presents to the ED after a mechanical fall down 6-7 stairs at home.
• Case 4: 63-year-old female presents to the ED for generalized weakness, dizziness, and fatigue.
• Case 5: 36-Year-Old Healthy Male Dropped A Car Tire On His Head At Work 2 Weeks Prior To His ED Visit. He Complains Of Worsening Headache.
• Case 6: 67-year-old male presents with 3 days of headache. He is alert with a GCS = 15 and a non-focal neurological exam.
• Case 7: 59-year-old male presents to the ED for headaches, confusion and gait instability after he hit his head at work 2 weeks prior.
• Case 8: 87-year-old male with a history of dementia and hypertension presents with family for the evaluation of altered mental status unsteady gait.
• Case 9: 73-year-old female presents to the ED after fall at home yesterday with subsequent development of headache and facial bruising.

References

Acute subdural haematoma

• Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, Servadei F, Walters BC, Wilberger JE; Surgical Management of Traumatic Brain Injury Author Group. Surgical management of acute subdural hematomas. Neurosurgery. 2006 Mar;58(3 Suppl):S16-24; discussion Si-iv. 
• Walcott BP, Khanna A, Kwon CS, Phillips HW, Nahed BV, Coumans JV. Time interval to surgery and outcomes following the surgical treatment of acute traumatic subdural hematoma. J Clin Neurosci. 2014 Dec;21(12):2107-11
• Tien HC, Jung V, Pinto R, Mainprize T, Scales DC, Rizoli SB. Reducing time-to-treatment decreases mortality of trauma patients with acute subdural hematoma. Ann Surg. 2011 Jun;253(6):1178-83.
• Hutchinson PJ et al. Decompressive Craniectomy versus Craniotomy for Acute Subdural Hematoma. N Engl J Med. 2023 Jun 15;388(24):2219-2229. 
• Gopinath S. Traumatic Acute Subdural Hematoma – Should the Bone Flap Be Removed or Replaced? N Engl J Med. 2023 Jun 15;388(24):2288-2289.
• Pruitt P, Ornam JV, Borczuk P. A Decision Instrument to Identify Isolated Traumatic Subdural Hematomas at Low Risk of Neurologic Deterioration, Surgical Intervention, or Radiographic Worsening. Acad Emerg Med. 2017 Nov;24(11):1377-1386. 
• Pruitt P, Castillo R, Rogers A, Prabhakaran S, Muschong K, Scudder M, McCarthy DM, Holl JL, Courtney DM, Borczuk P, Naidech A. External Validation of a Tool to Identify Low-Risk Patients With Isolated Subdural Hematoma and Preserved Consciousness. Ann Emerg Med. 2023 Sep 18:S0196-0644(23)01138-1.

Chronic subdural haematoma

• Rauhala M, Luoto TM, Huhtala H, Iverson GL, Niskakangas T, Öhman J, Helén P. The incidence of chronic subdural hematomas from 1990 to 2015 in a defined Finnish population. J Neurosurg. 2019 Mar 22;132(4):1147-1157.
• Almenawer SA, Farrokhyar F, Hong C, Alhazzani W, Manoranjan B, Yarascavitch B, Arjmand P, Baronia B, Reddy K, Murty N, Singh S. Chronic subdural hematoma management: a systematic review and meta-analysis of 34,829 patients. Ann Surg. 2014 Mar;259(3):449-57.
• Miah IP et al; DECSA Collaborators. Dexamethasone versus Surgery for Chronic Subdural Hematoma. N Engl J Med. 2023 Jun 15;388(24):2230-2240
• Bartley A, Bartek J Jr, Jakola AS, Sundblom J, Fält M, Förander P, Marklund N, Tisell M. Effect of Irrigation Fluid Temperature on Recurrence in the Evacuation of Chronic Subdural Hematoma: A Randomized Clinical Trial. JAMA Neurol. 2023 Jan 1;80(1):58-63.
• Tonetti DA, Thomas AJ, Bulsara KR. Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Review. Oper Neurosurg (Hagerstown). 2023 May 1;24(5):469-475.
• Kan P et al. Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Multi-Center Experience of 154 Consecutive Embolizations. Neurosurgery. 2021 Jan 13;88(2):268-277. 

Parafalcine Subdural Hematoma

• Howard BM, Rindler RS, Holland CM, Pradilla G, Ahmad FU. Management and Outcomes of Isolated Tentorial and Parafalcine “Smear” Subdural Hematomas at a Level-1 Trauma Center: Necessity of High Acuity Care. J Neurotrauma. 2017 Jan 1;34(1):128-136
• Cragun BN, Noorbakhsh MR, Hite Philp F, Suydam ER, Ditillo MF, Philp AS, Murdock AD. Traumatic Parafalcine Subdural Hematoma: A Clinically Benign Finding. J Surg Res. 2020 May;249:99-103

This neuroimaging interpretation series is proudly sponsored by the Emergency Medicine Residency Program at Carolinas Medical Center. The goal is to promote widespread mastery of CXR interpretation. There is no personal health information [PHI] within, and ages have been changed to protect patient confidentiality.