Evidence based diagnosis and management of chronic subdural hematoma: A review of the literature.

Journal Article (Journal Article;Review)

Chronic subdural hematomas are encapsulated blood collections within the dural border cells with characteristic outer "neomembranes". Affected patients are more often male and typically above the age of 70. Imaging shows crescentic layering of fluid in the subdural space on a non-contrast computed tomography (CT) scan, best appreciated on sagittal or coronal reformats. Initial medical management involves reversing anticoagulant/antiplatelet therapies, and often initiation of anti-epileptic drugs (AEDs). Operative interventions, such as twist-drill craniostomy (TDC), burr-hole craniostomy (BHC), and craniotomy are indicated if imaging implies compression (maximum fluid collection thickness >1 cm) or the patient is symptomatic. The effectiveness of various surgical techniques remains poorly characterized, with sparse level 1 evidence, variable outcome measures, and various surgical techniques. Postoperatively, subdural drains can decrease recurrence and sequential compression devices can decrease embolic complications, while measures such as early mobilization and re-initiation of anticoagulation need further study. Non-operative management, including steroid therapy, etizolam, tranexamic acid, and angiotensin converting enzyme inhibitors (ACEI) also remain poorly studied. Recurrent hemorrhages are a major complication affecting around 10-20% of patients, and therefore close follow-up is essential.

Full Text

Duke Authors

Cited Authors

  • Mehta, V; Harward, SC; Sankey, EW; Nayar, G; Codd, PJ

Published Date

  • April 2018

Published In

Volume / Issue

  • 50 /

Start / End Page

  • 7 - 15

PubMed ID

  • 29428263

Electronic International Standard Serial Number (EISSN)

  • 1532-2653

Digital Object Identifier (DOI)

  • 10.1016/j.jocn.2018.01.050


  • eng

Conference Location

  • Scotland