Subdural hematoma (SDH) (synonyms: Subdural hematoma; acute nontraumatic subdural hemorrhage; acute nontraumatic subdural hemorrhage; acute subdural hematoma; chronic subdural hematoma; dural hemorrhage; dural hematoma; nontraumatic; nontraumatic subdural hemorrhage; subacute nontraumatic subdural hemorrhage; subdural hemorrhage; subdural hemorrhage; subtentorial hemorrhage; subtentorial hemorrhage; subdural hematoma; traumatic subdural hematoma; traumatic subdural hemorrhage; traumatic subdural hemorrhage; ICD-10 S06. 5: Traumatic subdural hemorrhage; ICD-10 S06.5: Traumatic subdural hemorrhage; ICD-10 I62.0-: Subdural hemorrhage (nontraumatic)) is bleeding into the subdural space of the skull (between the dura mater (hard meninges) and the arachnoid mater (cobweb membrane; middle meninges)) or, more simply, between two meninges surrounding the brain.
Subdural hematoma belongs to intracranial hemorrhage (brain hemorrhage inside the skull) and, like epidural hematoma and subarachnoid hemorrhage (SAB), is an extracerebral hemorrhage (outside the skull; in the area of the meninges/ meninges) and thus should be distinguished from intracerebral hemorrhage (ICB; brain hemorrhage).
The following forms are distinguished:
- Acute subdural hematoma (aSDH).
- After severe traumatic brain injury (TBI) with brain contusions (cerebral contusions).
- Hemorrhage develops within a few hours; intracranial pressure increases
- Is accompanied by loss of consciousness
- Chronic subdural hematoma (cSDH) (>two weeks interval from trauma).
- Particularly affected are elderly patients and alcoholics after minor trauma (minor trauma) with small hemorrhage and patients taking anticoagulants (anticoagulants).
- Symptoms develop over weeks
- Often sufferers do not remember a causative event.
Traumatic subdural hematoma is found in 10-20% of all traumatic brain injuries (TBI).
In about 20% of cases, another type of hematoma such as subarachnoid hemorrhage or intracerebral hemorrhage (ICB) is present in addition to the subdural hematoma.
Peak incidence: between the ages of 70 and 79 years, the risk of subdural hematoma is increased 5-fold.
The incidence (frequency of new cases) for chronic subdural hematoma is approximately 5 cases per 100,000 people per year (in Western countries).
Course and prognosis: The prognosis of a subdural hematoma depends on the size of the hematoma as well as the symptoms. If the hematoma is recognized and treated in time, the prognosis is good. An acute subdural hemorrhage is an emergency – there is danger to life! To relieve the brain, a craniotomy (surgical opening of the bony skull) with opening of the dura mater and hematoma evacuation (clearing of the hematoma) must be performed as soon as possible. This is the only way to prevent an increase in intracranial pressure and life-threatening damage to the brain. Chronic subdural hemorrhages are also usually operated on, only here the time window is larger. If a chronic subdural hematoma does not cause any symptoms, treatment can initially be waited for. However, the bleeding must be monitored by regular CT scans. It is even possible for small chronic subdural hematomas to regress spontaneously.
The lethality (mortality based on the total number of people with the disease) of acute subdural hematoma ranges from 30% to 80%.
