What is the initial treatment of subdural hematoma (SDH)?

Updated: Jul 26, 2018
  • Author: Richard J Meagher, MD; Chief Editor: Helmi L Lutsep, MD  more...
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As with any trauma patient, resuscitation begins with the ABCs (airway, breathing, circulation). All patients with a Glasgow Coma Scale (GCS) score of less than 8 should be intubated for airway protection.

Despite prompt surgical evacuation of hematomas, patients with acute subdural hematomas often have a poor prognoses because of associated underlying brain injury. Patients often require intensive care postoperatively for ventilator-dependent respiration, strict blood pressure control, and management of intracranial hypertension.

The mechanism, exact pathophysiology, and optimal treatment for chronic subdural hematomas has still not been definitively determined. Further work in delineating why membranes form and how to prevent or reverse their formation may lead to improvements in treatment strategies.

When deciding whether to operate, consider the patient's prognosis. The ideal is to maximize the likelihood of appropriate resource allocation and, more importantly, allow for appropriate family counseling; keep in mind that no method of assessing the prognosis is 100% accurate.

Consult a neurosurgeon as soon as the diagnosis is suspected and initiate transfer if another facility is required for diagnosis or management.

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