Subdural Hematoma

Dive into the nuances of Subdural Hematoma with this informative guide. Explore the acute, subacute, and chronic phases, and discover crucial indications for surgical evacuation. From volume and thickness considerations to midline shift and GCS score, gain insights into the decision-making process for surgical intervention.

Subdural Hematoma

1. Acute: < 72 hours
2. Subacute: 3-7 days
3. Chronic : > 7 days

Indications for Surgical Evacuation

• Volume of bleed >30 ml
• >10mm thickness of bleed
• >5 mm midline shift regardless of GCS score
• If GCS <9
• If GCS drops by >2 points between time of event and time of evaluation
• If GCS < 9, needs ICP monitoring and if ICP > 20mm, evacuation needed
• If pupillary asymmetry present, evacuate.

Medical management:

1. Mannitol 0.25 gm/kg IV q 6 h
2. D/C if Serum measured osmolarity > 320 or Serum Sodium > 150.
3. Typically you can use it for upto 48 hours.