The Neurocritical and Neurosurgical Care of Subdural Hematomas.

Journal Article (Journal Article;Review)

Subdural hematomas (SDHs), though frequently grouped together, can result from a variety of different etiologies, and therefore many different subtypes exist. Moreover, the high incidence of these lesions in the neurocritical care settings behooves practitioners to have a firm grasp on their diagnosis and management. We present here a review of SDHs, with an emphasis on how different subtypes of SDHs differ from one another and with discussion of their medical and surgical management in the neurocritical care setting. In this paper, we discuss considerations for acute, subacute, and chronic SDHs and how presentation and management may change in both the elderly and pediatric populations. We discuss SDHs that arise in the setting of anticoagulation, those that arise in the setting of active cerebrospinal fluid diversion, and those that are recurrent and recalcitrant to initial surgical evacuation. Management steps reviewed include detailed discussion of initial assessment, anticoagulation reversal, seizure prophylaxis, blood pressure management, and indications for intracranial pressure monitoring. Direct surgical management options are reviewed, including open craniotomy, twist-drill, and burr-hole drainage and the usage of subdural drainage systems. SDHs are a common finding in the neurocritical care setting and have a diverse set of presentations. With a better understanding of the fundamental differences between subtypes of SDHs, critical care practitioners can better tailor their management of both the patient's intracranial and multi-systemic pathologies.

Full Text

Duke Authors

Cited Authors

  • Huang, KT; Bi, WL; Abd-El-Barr, M; Yan, SC; Tafel, IJ; Dunn, IF; Gormley, WB

Published Date

  • April 2016

Published In

Volume / Issue

  • 24 / 2

Start / End Page

  • 294 - 307

PubMed ID

  • 26399248

Electronic International Standard Serial Number (EISSN)

  • 1556-0961

Digital Object Identifier (DOI)

  • 10.1007/s12028-015-0194-x


  • eng

Conference Location

  • United States