Which imaging findings are prognostic indicators in subdural hematoma (SDH)?

Updated: Jul 26, 2018
  • Author: Richard J Meagher, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Findings on CT scan or MRI may help indicate prognosis. Such findings may include the following [15] :

  • Thickness or volume of the hematoma

  • Degree of midline shift

  • Presence of associated traumatic intraparenchymal lesions

  • Compression of the brainstem or basal cisterns

The first CT scan may underestimate the size of parenchymal contusions.

In general, a poor preoperative neurologic status may be a harbinger of a poor outcome. In addition to factors discussed above, poor prognostic indicators for acute subdural hematoma have been reported to include the following [16, 17, 15] :

  • Low initial (< 8) and postresuscitation (< 8) Glasgow coma scale

  • Low Glasgow coma scale motor score on admission (< 5)

  • Pupillary abnormalities

  • Alcohol use

  • Injury by motorcycle accident

  • Ischemic damage [18]

  • Hypoxia or hypotension

  • Difficulty in controlling ICP

Elevated ICP postoperatively indicates a poor prognosis and may indicate the severity of the underlying brain injury (eg, trauma, secondary infarction).


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