Subdural Hematoma: Or something else? Differential Diagnosis

Endocrine, nutritional, and metabolic diseases (E00-E90).

  • Coma diabeticum (coma due to metabolic derailment in the setting of diabetes mellitus/sugar disease).

Cardiovascular system (I00-I99).

  • Apoplexy (stroke)
  • Extracranial carotid stenosis – narrowing of the carotid artery outside the bony skull (extracranial).
  • Extracerebral hemorrhage
    • Epidural hematoma (synonyms: epidural hematoma; epidural hemorrhage; epidural hemorrhage) – bleeding into the epidural space (space between the bones of the skull and the dura mater (hard meninges, outer boundary of the brain to the skull)).
      • Cause: rupture (tear) of the middle meningeal artery (common) or rupture of a venous sinus (bulge or hollowed structure of venous blood vessels) (rare)
      • Approximately two-thirds of those affected are younger than 40 years; in young children, epidural hematomas are very common after skull injuries in the first two years of life
      • Sex ratio: males to females is 5: 1
    • Subarachnoid hemorrhage (SAB) – arterial hemorrhage into the subarachnoid space (cleft space between the arachnoid mater (cobweb membrane; middle meninges) and the pia mater (delicate meninges that directly overlie the brain)).
      • Represents a common, neurologic emergency
      • Cause: rupture of an intracranial aneurysm (pathologic/diseased bulging of vessel walls in the brain) or angioma (benign vascular neoplasm) (rare)
      • Sex ratio: women are more commonly affected than men.
      • Frequency peak: the disease occurs mainly between the 40th and 60th year of life.
      • Incidence (frequency of new cases): 20 diseases per 100,000 inhabitants per year (in Germany).
  • Intracerebral hemorrhage (ICB; cerebral hemorrhage).
  • Subdural hygroma – accumulation of cerebrospinal fluid (CSF) in the subdural space.

Neoplasms – tumor diseases (C00-D48).

  • Brain tumor

Psyche – nervous system (F00-F99; G00-G99)

  • Dementia – just in milder forms of impaired consciousness.
  • Brain abscess – accumulation of pus in the brain (headache, nausea, vomiting, epileptic seizures, clouding of consciousness).
  • Alzheimer’s disease
  • Subclavian steal syndrome (synonym: vertebral tapping syndrome) – a so-called tapping syndrome. This refers to a condition in which there is blood withdrawal in a specific area as a result of localized blood flow reversal.
  • Subdural abscess (accumulation of pus below the dura mater) – usually in the context of ethmoidal and frontal sinusitis.
  • Transient ischemic attack (TIA) – sudden onset of circulatory disturbance in the brain leading to neurological disturbances that resolve within 24 hours

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99)

  • Acute paresis (paralysis).
  • Aphasia (speech disorders)
  • Cephalgia (headache)