What neurologic findings suggest acute subdural hematoma (SDH)?

Updated: Jul 26, 2018
  • Author: Richard J Meagher, MD; Chief Editor: Helmi L Lutsep, MD  more...
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The clinical presentation of a patient with an acute subdural hematoma depends on the size of the hematoma and the degree of any associated parenchymal brain injury. Symptoms associated with acute subdural hematoma include the following:

  • Headache

  • Nausea

  • Confusion

  • Personality change

  • Decreased level of consciousness

  • Speech difficulties

  • Other change in mental status

  • Impaired vision or double vision

  • Weakness

Of course, such symptoms could also be caused by other conditions.

Neurologic findings associated with acute subdural hematoma may include the following:

  • Altered level of consciousness

  • A dilated or nonreactive pupil ipsilateral to the hematoma (or earlier, a pupil with a more limited range of reaction)

  • Hemiparesis contralateral to the hematoma

A host of findings could be associated with these, such as brisk or abnormal reflexes, aphasia (usually with a left-sided hematoma), upper-extremity drift, or impairment of cortical sensory function. Less common findings include papilledema and unilateral or bilateral cranial nerve VI palsy. Some of the above may occur later in the clinical course; for instance, coma with a dilated fixed pupil usually indicates unilateral transtentorial herniation. Lack of a finding (eg, papilledema) cannot rule out subdural hematoma.

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