What is the role of imaging studies in the workup of subdural hematoma (SDH)?

Updated: Jul 26, 2018
  • Author: Richard J Meagher, MD; Chief Editor: Helmi L Lutsep, MD  more...
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An emergent computed tomography (CT) scan of the head needs to be performed when an acute subdural hematoma is suspected. It should be obtained immediately after the patient is stabilized using standard Advanced Trauma Life Support (ATLS) guidelines. CT scanning is also the initial imaging modality of choice for chronic subdural hematoma.

The trauma team and neurosurgeon must determine quickly which lesions warrant immediate evacuation, and CT is the imaging modality of choice to facilitate this decision. Modern CT devices can produce appropriate images in about 5 minutes, and the scans are highly sensitive to acute blood. Although magnetic resonance imaging (MRI) is superior for demonstrating the size of an acute subdural hematoma and its effect on the brain, noncontrast head CT is the primary means of making a diagnosis and suffices for immediate management purposes.

A worsening of the Glasgow Coma Scale by 2 or more points should prompt repeat imaging in salvageable patients. A cervical spine radiograph series is important in evaluating the possibility of concomitant cervical spine fracture.

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