The medical history represents an important component in the diagnosis of subdural hematoma (SDH).
If acute subdural hematoma is suspected, the patient is admitted to the hospital as a medical emergency. If the patient is unresponsive, the medical history must be taken with relatives or contacts (= external medical history).
Family history
- Are there frequent cardiovascular diseases, metabolic diseases, neurological diseases or tumor diseases in your family?
Current anamnesis/systemic anamnesis (somatic and psychological complaints) (as a rule, an external anamnesis is taken).
- Was there an accident?
- Do you remember falling or hitting your head?
- Was or is there any loss of consciousness?
- Were or are there other symptoms such as nausea, vomiting?
- Do you feel a sense of pressure in the head or suffer from headaches?
- Did you experience any epileptic seizures (convulsions)?
- Has your ability to concentrate decreased?
- If so, how long have these symptoms existed ?
- Have these symptoms occurred previously?*
Vegetative anamnesis including nutritional anamnesis.
- Do you smoke? If yes, how many cigarettes, cigars or pipes per day?
- Do you drink alcohol? If yes, what drink(s) and how many glasses per day?
- Do you use drugs? If yes, what drugs and how often per day or per week?
Self-history
- Pre-existing conditions (hypertension/high blood pressure, diabetes mellitus).
Medication history
- Anticoagulants
- Coumarins (phenprocoumon* (product names: Marcumar, Falithrom); warfarin (product names: Coumadin, Marevan); acenocoumarol (product name: Sintrom).
- Direct inhibitors of thrombin (Argatroban, Lepirudin).
- Heparin analogues (fondaparinux).
- Heparins (certoparin, dalteparin, enoxaparin, nadroparin, reviparin, tinzaparin).
- Heparinoids (danaparoid
- New oral anticoagulants (NOAK; NOAC; direct oral anticoagulants, DOAK).
- Direct factor Xa inhibitor (apixaban, edoxaban, rivaroxaban).
- Direct and selective factor Xa inhibitor (apixaban).
- Selective thrombin inhibitor (dabigatran); antidote: idarucizumab can reverse the effect of the oral anticoagulant dabigatran within minutes; bleeding stops within 2.5 hours-but there may be a rebound in bleeding times after 12 to 24 hours, leading to rebleeding in some patients.
- Antiplatelet agents (abciximab, acetylsalicylic acid (ASA), combination of acetylsalicylic acid and dipyridamole, clopidogrel, eptifibatide, ilomedin (prostacyclin analog), prasugrel, ticagrelor, ticlopidine, tirofiban)Low-dose (up to 300 mg/day) continuous medication with acetylsalicylic acid (ASA; Antiplatelet agents), as prescribed for primary and secondary prevention of vascular events, does not increase the risk of intracranial hemorrhage.
- Fibrinolytics (drugs used for the acute treatment of conditions caused by vascular occlusion; they cause the blood clot to dissolve).
* If this question has been answered with “Yes”, an immediate visit to the doctor is required! (Information without guarantee)
