The BrightSide

Acute Subdural Hematoma :Etiology, Prognosis , Treatments.
#Etiology

If you sustain a major brain injury, this area can fill with blood and cause life-threatening symptoms. This is called an acute subdural hematoma. It’s the most dangerous type of subdural hematoma.
Acute subdural hematomas are usually caused by:
-Head trauma
-Coagulopathy or medical anticoagulation (eg, warfarin [Coumadin], heparin, hemophilia, liver disease, thrombocytopenia)
-Nontraumatic intracranial hemorrhage due to cerebral aneurysm, arteriovenous malformation, or tumor (meningioma or dural metastases)
-Postsurgical (craniotomy, CSF shunting)
-Intracranial hypotension (eg, after lumbar puncture, lumbar CSF leak, lumboperitoneal shunt, spinal epidural anesthesia 
-Child abuse or shaken baby syndrome (in the pediatric age group)
-Spontaneous or unknown (rare)

Acute subdural hematomas form quickly, and the symptoms appear immediately. About 50 to 90 percentage of people who develop acute subdural hematomas die from the condition or its complications.Significant trauma is not the only cause of subdural hematoma. Chronic subdural hematoma can occur in the elderly after apparently insignificant head trauma. Often, the antecedent event is never recognized. Chronic subdural hematoma is a common treatable cause of dementia. A minority of chronic subdural hematoma cases derived from acute subdural hematomas that have matured (ie, liquefied) because of lack of treatment.

#Prognosis

-Findings on CT scan or MRI may help indicate prognosis.

-Low initial (< 8) and postresuscitation (< 8) Glasgow coma scale
-Low Glasgow coma scale motor score on admission (< 5)
-Pupillary abnormalities
-Alcohol use
-Injury by motorcycle accident
-Ischemic damage 
-Hypoxia or hypotension
-Difficulty in controlling ICP

#Treatment 

Surgery for emergent decompression has been advocated if the acute subdural hematoma is associated with a midline shift greater than or equal to 5 mm. Surgery also has been recommended for acute subdural hematomas exceeding 1 cm in thickness.acute subdural hematoma less than 1 cm in thickness causing a midline shift of less than 5 mm if any of the following criteria are met:
-The GCS score decreases by 2 or more points between the time of injury and hospital evaluation
-The patient presents with fixed and dilated pupils
-The intracranial pressure (ICP) exceeds 20 mm Hg.