Subdural hemorrhage - Revision history

Danbot: Strip excess bold

2026-03-22T09:26:55Z

Strip excess bold

← Older revision		Revision as of 09:26, 22 March 2026
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	*Bleeding between the dura mater and arachnoid membrane, typically from bridging vein rupture		*Bleeding between the dura mater and arachnoid membrane, typically from bridging vein rupture
	*Three types by timing:		*Three types by timing:
	**~~'''~~Acute~~'''~~ (<3 days) — hyperdense (white) on CT		**Acute (<3 days) — hyperdense (white) on CT
	**~~'''~~Subacute~~'''~~ (3-21 days) — isodense (may be difficult to see)		**Subacute (3-21 days) — isodense (may be difficult to see)
	**~~'''~~Chronic~~'''~~ (>21 days) — hypodense (dark) on CT		**Chronic (>21 days) — hypodense (dark) on CT
	*Most common in elderly and anticoagulated patients<ref name="karibe">Karibe H, et al. Surgical management of traumatic acute subdural hematoma in adults. ''Neurol Med Chir (Tokyo)''. 2014;54(11):887-894. PMID 25367584.</ref>		*Most common in elderly and anticoagulated patients<ref name="karibe">Karibe H, et al. Surgical management of traumatic acute subdural hematoma in adults. ''Neurol Med Chir (Tokyo)''. 2014;54(11):887-894. PMID 25367584.</ref>
	*Acute SDH mortality: 50-90% (highest of all traumatic intracranial lesions)		*Acute SDH mortality: 50-90% (highest of all traumatic intracranial lesions)
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	==Evaluation==		==Evaluation==
	*~~'''~~Non-contrast CT head~~'''~~ — test of choice<ref name="bullock2">Bullock MR, et al. Surgical management of acute subdural hematomas. ''Neurosurgery''. 2006;58(3 Suppl):S16-24. PMID 16710968.</ref>		*Non-contrast CT head — test of choice<ref name="bullock2">Bullock MR, et al. Surgical management of acute subdural hematomas. ''Neurosurgery''. 2006;58(3 Suppl):S16-24. PMID 16710968.</ref>
	**Acute: hyperdense, crescent-shaped collection crossing suture lines		**Acute: hyperdense, crescent-shaped collection crossing suture lines
	**Chronic: hypodense, crescent-shaped; may have mixed density if rebleeding		**Chronic: hypodense, crescent-shaped; may have mixed density if rebleeding
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	===Acute SDH===		===Acute SDH===
	*'''ABCs''' — intubate if GCS <=8		*'''ABCs''' — intubate if GCS <=8
	*~~'''~~Emergent neurosurgical consultation~~'''~~		*Emergent neurosurgical consultation
	*'''Reverse anticoagulation''' immediately:		*'''Reverse anticoagulation''' immediately:
	**Warfarin: ~~'''~~4-factor PCC~~'''~~ (25-50 units/kg) + ~~'''~~Vitamin K~~'''~~ 10 mg IV		**Warfarin: 4-factor PCC (25-50 units/kg) + Vitamin K 10 mg IV
	**Dabigatran: ~~'''~~Idarucizumab~~'''~~ 5 g IV		**Dabigatran: Idarucizumab 5 g IV
	**Rivaroxaban/Apixaban: ~~'''~~Andexanet alfa~~'''~~ or ~~'''~~4-factor PCC~~'''~~		**Rivaroxaban/Apixaban: Andexanet alfa or 4-factor PCC
	**Antiplatelet agents: platelet transfusion if surgical candidate		**Antiplatelet agents: platelet transfusion if surgical candidate
	*ICP management: head of bed elevation, osmotherapy ([[Mannitol]] or [[Hypertonic saline]])		*ICP management: head of bed elevation, osmotherapy ([[Mannitol]] or [[Hypertonic saline]])
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	==Disposition==		==Disposition==
	*All acute SDH: ~~'''~~admit~~'''~~, neurosurgical evaluation, ICU for operative or declining patients		*All acute SDH: admit, neurosurgical evaluation, ICU for operative or declining patients
	*Chronic SDH: admit if symptomatic, new, or enlarging; small stable chronic SDH may have outpatient neurosurgery follow-up		*Chronic SDH: admit if symptomatic, new, or enlarging; small stable chronic SDH may have outpatient neurosurgery follow-up

Danbot: Major expansion: acute vs chronic features, anticoagulation reversal, surgical indications, peer-reviewed references

2026-03-21T18:34:23Z

Major expansion: acute vs chronic features, anticoagulation reversal, surgical indications, peer-reviewed references

← Older revision		Revision as of 18:34, 21 March 2026
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	==Background==		==Background==
	~~[[File~~:~~Meninges-en.svg\|thumb\|Anatomy of the meninges]]~~		*Bleeding between the dura mater and arachnoid membrane, typically from bridging vein rupture
	*~~Can present as acute~~ (<14 days) ~~and chronic~~ (>14 days)		*Three types by timing:
	*~~Both types are caused by sudden acceleration~~-~~deceleration of the brain with resultant shearing of the bridging veins~~.		**'''Acute''' (<3 days) — hyperdense (white) on CT
	**~~Blood pools between~~ the ~~dura mater~~ and ~~arachnoid~~		**'''Subacute''' (3-21 days) — isodense (may be difficult to see)
	*~~Patients with extreme~~ atrophy ~~are at increased risk (elderly, alcoholics~~)		**'''Chronic''' (>21 days) — hypodense (dark) on CT
	**Patients less than 2 years old are also at increased risk		*Most common in elderly and anticoagulated patients<ref name="karibe">Karibe H, et al. Surgical management of traumatic acute subdural hematoma in adults. ''Neurol Med Chir (Tokyo)''. 2014;54(11):887-894. PMID 25367584.</ref>
	*~~SDH are often associated with other~~ [[~~TBI~~\|~~brain injuries~~]]		*Acute SDH mortality: 50-90% (highest of all traumatic intracranial lesions)
			*May occur with minimal or no trauma in the elderly and anticoagulated

			==Risk Factors==
			*Advanced age (cerebral atrophy stretches bridging veins)
			*Anticoagulation / antiplatelet therapy
			*Chronic [[Ethanol toxicity\|alcohol use]] (cerebral atrophy, coagulopathy)
			*Coagulopathy or thrombocytopenia
			*Prior falls or head trauma (even minor)
			*CSF shunt (overdrainage)

	==Clinical Features==		==Clinical Features==
	*~~Patients with acute SDH generally will present unconscious after a severe~~ [[~~head trauma\|trauma~~]]		===Acute SDH===
	*~~Patients~~ with ~~chronic~~ SDH ~~generally present with~~ [[~~altered mental status~~]] or ~~vague complaints~~		*Headache, altered mental status, decreasing [[GCS]]
	*~~High index of suspicion warranted in the aforementioned groups of patients at increased risk with any history~~ of ~~head~~ trauma ~~regardless of severity~~		*Ipsilateral fixed/dilated pupil (uncal herniation)
			*Contralateral hemiparesis
			*May present with coma from onset
			*Associated with high-energy mechanism or fall in anticoagulated patients

			===Chronic SDH===
			*Insidious onset over weeks to months
			*Headache, cognitive decline, confusion, personality changes
			*Gait disturbance, falls
			*Fluctuating neurologic symptoms (may mimic [[Stroke (main)\|stroke]] or [[Dementia\|dementia]])
			*History of trauma often absent or trivial

	==Differential Diagnosis==		==Differential Diagnosis==
	~~{{Intracranial~~ hemorrhage ~~DDX}}~~		*[[Epidural hemorrhage]]
			*[[Subarachnoid hemorrhage]]
			*[[Intracerebral hemorrhage]]
			*[[Stroke (main)\|Ischemic stroke]]
			*[[Meningitis]]
			*[[Dementia]] (chronic SDH)

	==Evaluation==		==Evaluation==
	~~[[File~~:~~Subduralandherniation~~.~~png\|thumb\|Large left-sided frontal-parietal subdural hematoma with associated midline shift~~.]]		*'''Non-contrast CT head''' — test of choice<ref name="bullock2">Bullock MR, et al. Surgical management of acute subdural hematomas. ''Neurosurgery''. 2006;58(3 Suppl):S16-24. PMID 16710968.</ref>
	~~{{Head trauma workup}}~~		**Acute: hyperdense, crescent-shaped collection crossing suture lines
	*Noncontrast [[head CT\|CT]] brain is the gold standard		**Chronic: hypodense, crescent-shaped; may have mixed density if rebleeding
	**Acute ~~SDH will show as a~~ hyperdense ~~(white) collection with a~~ crescent-shaped ~~appearance~~		**Evaluate for midline shift, mass effect, herniation
	**Chronic ~~SDH will show as a~~ hypodense ~~(dark grey/black) collection in a~~ crescent-~~shape~~		*Labs: CBC, coagulation studies (PT/INR, PTT), type and screen
	**~~Contrasted~~ studies ~~are useful in distinguishing acute~~, ~~subacute~~, and ~~chronic~~		*If on anticoagulation: specific reversal levels (e.g., anti-Xa for DOACs)

	==Management==		==Management==
	*~~See [[Head trauma (main)]]~~		===Acute SDH===
	*Emergent neurosurgical ~~evacuation~~		*'''ABCs''' — intubate if GCS <=8
	**Operative intervention generally for patients with focal findings, >10mm hematoma, midline shift > 5mm, signs of increased intracranial pressure (ICP)<ref>Bullock MR, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006; 58(3):~~S16~~-~~24</ref> <ref>Evans JA, et al. A simple tool to identify elderly patients with a surgically important acute subdural haematoma. Injury. 2015 Jan;46~~(~~91):76~~-9</~~ref>~~		*'''Emergent neurosurgical consultation'''
	*Management of [[elevated ICP\|ICP]]		*'''Reverse anticoagulation''' immediately:
	**~~Head of bed to 30 degrees~~		**Warfarin: '''4-factor PCC''' (25-50 units/kg) + '''Vitamin K''' 10 mg IV
	**~~Short~~-~~term use of hyperventilation~~		**Dabigatran: '''Idarucizumab''' 5 g IV
	**~~Hyperosmolar~~ agents ([[Mannitol]], [[~~hypertonic saline\|3%~~ saline]])		**Rivaroxaban/Apixaban: '''Andexanet alfa''' or '''4-factor PCC'''
	*~~[[Anticoagulant reversal\|Reversal of anticoagulation]]~~		**Antiplatelet agents: platelet transfusion if surgical candidate
	*~~Treat and prevent hypotension and hypoxia~~		*ICP management: head of bed elevation, osmotherapy ([[Mannitol]] or [[Hypertonic saline]])
	**~~Associated~~ with significantly increased mortality<ref>Chesnut, R.M., Marshall, L.F., Klauber, M.R., Blunt, B.A., Baldwin, N., Eisenberg, H.M., Jane, J.A., Marmarou, A. and Foulkes, M.A. (1993) ‘THE ROLE OF SECONDARY BRAIN INJURY IN DETERMINING OUTCOME FROM SEVERE HEAD INJURY’, The Journal of Trauma: ~~Injury, Infection, and Critical Care, 34~~(2)~~, pp. 216–222.</ref>~~		*Surgical indications: clot thickness >10 mm, midline shift >5 mm, GCS drop >=2 points
	*Emergency Department [[Burr hole]], if indicated
			===Chronic SDH===
			*Neurosurgical consultation for possible burr hole drainage
			*Reverse anticoagulation
			*Many small, asymptomatic chronic SDH may be observed with serial imaging
			*Symptomatic chronic SDH: typically surgical (burr hole or craniotomy)

	==Disposition==		==Disposition==
	*~~Admission to~~ neurosurgery ~~or trauma surgery~~		*All acute SDH: '''admit''', neurosurgical evaluation, ICU for operative or declining patients
			*Chronic SDH: admit if symptomatic, new, or enlarging; small stable chronic SDH may have outpatient neurosurgery follow-up

	==See Also==		==See Also==
	*[[~~Intracranial Hemorrhage~~ (~~Main~~)]]		*[[Epidural hemorrhage]]
	*[[~~Head Trauma~~]]		*[[Head trauma (main)]]
			*[[Subarachnoid hemorrhage]]
	~~==External Links==~~		*[[Anticoagulation reversal]]
	*[~~http://radiopaedia.org/articles/subdural-haemorrhage SDH Radiographs~~]

	==References==		==References==
	<references/>		<references/>

			[[Category:Neurology]]
	[[Category:Trauma]]		[[Category:Trauma]]
	~~[[Category:Neurology]]~~

ClaireLewis at 16:21, 3 October 2019

2019-10-03T16:21:00Z

← Older revision		Revision as of 16:21, 3 October 2019
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	*Patients with extreme atrophy are at increased risk (elderly, alcoholics)		*Patients with extreme atrophy are at increased risk (elderly, alcoholics)
	**Patients less than 2 years old are also at increased risk		**Patients less than 2 years old are also at increased risk
	*SDH are often associated with other brain injuries		*SDH are often associated with other [[TBI\|brain injuries]]

	==Clinical Features==		==Clinical Features==
	*Patients with acute SDH generally will present unconscious after a severe trauma		*Patients with acute SDH generally will present unconscious after a severe [[head trauma\|trauma]]
	*Patients with chronic SDH generally present with altered mental status or vague complaints		*Patients with chronic SDH generally present with [[altered mental status]] or vague complaints
	*High index of suspicion warranted in the aforementioned groups of patients at increased risk with any history of head trauma regardless of severity		*High index of suspicion warranted in the aforementioned groups of patients at increased risk with any history of head trauma regardless of severity

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	[[File:Subduralandherniation.png\|thumb\|Large left-sided frontal-parietal subdural hematoma with associated midline shift.]]		[[File:Subduralandherniation.png\|thumb\|Large left-sided frontal-parietal subdural hematoma with associated midline shift.]]
	{{Head trauma workup}}		{{Head trauma workup}}
	*Noncontrast CT ~~Brain~~ is the gold standard		*Noncontrast [[head CT\|CT]] brain is the gold standard
	**Acute SDH will show as a hyperdense (white) collection with a crescent-shaped appearance		**Acute SDH will show as a hyperdense (white) collection with a crescent-shaped appearance
	**Chronic SDH will show as a hypodense (dark grey/black) collection in a crescent-shape		**Chronic SDH will show as a hypodense (dark grey/black) collection in a crescent-shape
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	*Emergent neurosurgical evacuation		*Emergent neurosurgical evacuation
	**Operative intervention generally for patients with focal findings, >10mm hematoma, midline shift > 5mm, signs of increased intracranial pressure (ICP)<ref>Bullock MR, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006; 58(3):S16-24</ref> <ref>Evans JA, et al. A simple tool to identify elderly patients with a surgically important acute subdural haematoma. Injury. 2015 Jan;46(91):76-9</ref>		**Operative intervention generally for patients with focal findings, >10mm hematoma, midline shift > 5mm, signs of increased intracranial pressure (ICP)<ref>Bullock MR, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006; 58(3):S16-24</ref> <ref>Evans JA, et al. A simple tool to identify elderly patients with a surgically important acute subdural haematoma. Injury. 2015 Jan;46(91):76-9</ref>
	*Management of ICP		*Management of [[elevated ICP\|ICP]]
	**Head of bed to 30 degrees		**Head of bed to 30 degrees
	**Short-term use of hyperventilation		**Short-term use of hyperventilation
	**Hyperosmolar agents ([[Mannitol]], 3% saline)		**Hyperosmolar agents ([[Mannitol]], [[hypertonic saline\|3% saline]])
	*[[~~Coagulopathy (Main)~~\|Reversal of anticoagulation]]		*[[Anticoagulant reversal\|Reversal of anticoagulation]]
	*Treat and prevent hypotension and hypoxia		*Treat and prevent hypotension and hypoxia
	**Associated with significantly increased mortality<ref>Chesnut, R.M., Marshall, L.F., Klauber, M.R., Blunt, B.A., Baldwin, N., Eisenberg, H.M., Jane, J.A., Marmarou, A. and Foulkes, M.A. (1993) ‘THE ROLE OF SECONDARY BRAIN INJURY IN DETERMINING OUTCOME FROM SEVERE HEAD INJURY’, The Journal of Trauma: Injury, Infection, and Critical Care, 34(2), pp. 216–222.</ref>		**Associated with significantly increased mortality<ref>Chesnut, R.M., Marshall, L.F., Klauber, M.R., Blunt, B.A., Baldwin, N., Eisenberg, H.M., Jane, J.A., Marmarou, A. and Foulkes, M.A. (1993) ‘THE ROLE OF SECONDARY BRAIN INJURY IN DETERMINING OUTCOME FROM SEVERE HEAD INJURY’, The Journal of Trauma: Injury, Infection, and Critical Care, 34(2), pp. 216–222.</ref>
Line 38:		Line 38:

	==Disposition==		==Disposition==
	*Admission to NS or trauma surgery		*Admission to neurosurgery or trauma surgery

	==See Also==		==See Also==

Rossdonaldson1: /* Background */

2016-09-18T19:57:47Z

Background

← Older revision		Revision as of 19:57, 18 September 2016
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	==Background==		==Background==
			[[File:Meninges-en.svg\|thumb\|Anatomy of the meninges]]
	*Can present as acute (<14 days) and chronic (>14 days)		*Can present as acute (<14 days) and chronic (>14 days)
	*Both types are caused by sudden acceleration-deceleration of the brain with resultant shearing of the bridging veins.		*Both types are caused by sudden acceleration-deceleration of the brain with resultant shearing of the bridging veins.

Kxl328 at 21:07, 29 August 2016

2016-08-29T21:07:36Z

← Older revision		Revision as of 21:07, 29 August 2016
Line 24:		Line 24:

	==Management==		==Management==
			*See [[Head trauma (main)]]
	*Emergent neurosurgical evacuation		*Emergent neurosurgical evacuation
	**Operative intervention generally for patients with focal findings, >10mm hematoma, midline shift > 5mm, signs of increased intracranial pressure (ICP)<ref>Bullock MR, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006; 58(3):S16-24</ref> <ref>Evans JA, et al. A simple tool to identify elderly patients with a surgically important acute subdural haematoma. Injury. 2015 Jan;46(91):76-9</ref>		**Operative intervention generally for patients with focal findings, >10mm hematoma, midline shift > 5mm, signs of increased intracranial pressure (ICP)<ref>Bullock MR, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006; 58(3):S16-24</ref> <ref>Evans JA, et al. A simple tool to identify elderly patients with a surgically important acute subdural haematoma. Injury. 2015 Jan;46(91):76-9</ref>

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-25T19:23:24Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 19:23, 25 July 2016
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	{{Intracranial hemorrhage DDX}}		{{Intracranial hemorrhage DDX}}

	==~~Diagnosis~~==		==Evaluation==
	[[File:Subduralandherniation.png\|thumb\|Large left-sided frontal-parietal subdural hematoma with associated midline shift.]]		[[File:Subduralandherniation.png\|thumb\|Large left-sided frontal-parietal subdural hematoma with associated midline shift.]]
	{{Head trauma workup}}		{{Head trauma workup}}

Kian: ref for hypoxia/hypotension

2016-05-21T09:19:47Z

ref for hypoxia/hypotension

← Older revision		Revision as of 09:19, 21 May 2016
Line 31:		Line 31:
	**Hyperosmolar agents ([[Mannitol]], 3% saline)		**Hyperosmolar agents ([[Mannitol]], 3% saline)
	*[[Coagulopathy (Main)\|Reversal of anticoagulation]]		*[[Coagulopathy (Main)\|Reversal of anticoagulation]]
			*Treat and prevent hypotension and hypoxia
			**Associated with significantly increased mortality<ref>Chesnut, R.M., Marshall, L.F., Klauber, M.R., Blunt, B.A., Baldwin, N., Eisenberg, H.M., Jane, J.A., Marmarou, A. and Foulkes, M.A. (1993) ‘THE ROLE OF SECONDARY BRAIN INJURY IN DETERMINING OUTCOME FROM SEVERE HEAD INJURY’, The Journal of Trauma: Injury, Infection, and Critical Care, 34(2), pp. 216–222.</ref>
	*Emergency Department [[Burr hole]], if indicated		*Emergency Department [[Burr hole]], if indicated

Ostermayer: Text replacement - "Category:Neuro" to "Category:Neurology"

2016-03-22T14:15:04Z

Text replacement - "Category:Neuro" to "Category:Neurology"

← Older revision		Revision as of 14:15, 22 March 2016
Line 47:		Line 47:

	[[Category:Trauma]]		[[Category:Trauma]]
	[[Category:~~Neuro~~]]		[[Category:Neurology]]

Kurtucla05: included reference to new paper suggesting who needs to go to OR with SDH

2015-08-08T17:59:40Z

included reference to new paper suggesting who needs to go to OR with SDH

← Older revision		Revision as of 17:59, 8 August 2015
Line 25:		Line 25:
	==Management==		==Management==
	*Emergent neurosurgical evacuation		*Emergent neurosurgical evacuation
	**Operative intervention generally for patients with focal findings, >10mm hematoma, midline shift > 5mm, signs of increased intracranial pressure (ICP)<ref>Bullock MR, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006; 58(3):S16-24</ref>		**Operative intervention generally for patients with focal findings, >10mm hematoma, midline shift > 5mm, signs of increased intracranial pressure (ICP)<ref>Bullock MR, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006; 58(3):S16-24</ref> <ref>Evans JA, et al. A simple tool to identify elderly patients with a surgically important acute subdural haematoma. Injury. 2015 Jan;46(91):76-9</ref>
	*Management of ICP		*Management of ICP
	**Head of bed to 30 degrees		**Head of bed to 30 degrees

Mholtz at 04:38, 23 July 2015

2015-07-23T04:38:20Z

← Older revision		Revision as of 04:38, 23 July 2015
Line 1:		Line 1:
	==Background==		==Background==
	* Can present as acute (<14 days) and chronic (>14 days)		*Can present as acute (<14 days) and chronic (>14 days)
	* Both types are caused by sudden acceleration-deceleration of the brain with resultant shearing of the bridging veins.		*Both types are caused by sudden acceleration-deceleration of the brain with resultant shearing of the bridging veins.
	** Blood pools between the dura mater and arachnoid		**Blood pools between the dura mater and arachnoid
	* Patients with extreme atrophy are at increased risk (elderly, alcoholics)		*Patients with extreme atrophy are at increased risk (elderly, alcoholics)
	** Patients less than 2 years old are also at increased risk		**Patients less than 2 years old are also at increased risk
	* SDH are often associated with other brain injuries		*SDH are often associated with other brain injuries

			==Clinical Features==
			*Patients with acute SDH generally will present unconscious after a severe trauma
			*Patients with chronic SDH generally present with altered mental status or vague complaints
			*High index of suspicion warranted in the aforementioned groups of patients at increased risk with any history of head trauma regardless of severity

			==Differential Diagnosis==
			{{Intracranial hemorrhage DDX}}

	==Diagnosis==		==Diagnosis==
	* Patients with acute SDH generally will present unconscious after a severe trauma
	* Patients with chronic SDH generally present with altered mental status or vague complaints
	* High index of suspicion warranted in the aforementioned groups of patients at increased risk with any history of head trauma regardless of severity

	~~==Workup==~~
	[[File:Subduralandherniation.png\|thumb\|Large left-sided frontal-parietal subdural hematoma with associated midline shift.]]		[[File:Subduralandherniation.png\|thumb\|Large left-sided frontal-parietal subdural hematoma with associated midline shift.]]
	{{Head trauma workup}}		{{Head trauma workup}}
	* ~~Head~~ CT is the gold standard		*Noncontrast CT Brain is the gold standard
	** Acute SDH will show as a hyperdense (white) collection with a crescent-shaped appearance		**Acute SDH will show as a hyperdense (white) collection with a crescent-shaped appearance
	** Chronic SDH will show as a hypodense (dark grey/black) collection in a crescent-shape		**Chronic SDH will show as a hypodense (dark grey/black) collection in a crescent-shape
	** Contrasted studies are useful in distinguishing acute, subacute, and chronic		**Contrasted studies are useful in distinguishing acute, subacute, and chronic

	~~==Differential Diagnosis==~~
	~~{{Intracranial hemorrhage DDX}}~~

	==Management==		==Management==
	* Emergent neurosurgical evacuation		*Emergent neurosurgical evacuation
	** Operative intervention generally for patients with focal findings, >10mm hematoma, midline shift > 5mm, signs of increased intracranial pressure (ICP)<ref>Bullock MR, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006; 58(3):S16-24</ref>		**Operative intervention generally for patients with focal findings, >10mm hematoma, midline shift > 5mm, signs of increased intracranial pressure (ICP)<ref>Bullock MR, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006; 58(3):S16-24</ref>
	* Management of ICP		*Management of ICP
	** Head of bed to 30 degrees		**Head of bed to 30 degrees
	** Short-term use of hyperventilation		**Short-term use of hyperventilation
	** Hyperosmolar agents ([[Mannitol]], 3% saline)		**Hyperosmolar agents ([[Mannitol]], 3% saline)
	* [[Coagulopathy (Main)\|Reversal of anticoagulation]]		*[[Coagulopathy (Main)\|Reversal of anticoagulation]]
	* ~~Trephination (~~Burr ~~holes)~~		*Emergency Department [[Burr hole]], if indicated

	==Disposition==		==Disposition==
	*Admission to NS or trauma surgery		*Admission to NS or trauma surgery
	*Considered high level of care for q1-2hr neuro checks

	==See Also==		==See Also==