Subdural hematoma diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Diagnostic Study of Choice
Study of choice
The diagnostic study of choice for subdural hematoma is CT scan.
Brain CT scan must be performed when:
- The patient presents with history of head trauma, headache, personality changes, gait abnormalities and evidence of increased intracranial pressure.
Investigations:
- Among the patients who present with clinical signs of subdural hematoma the CT scan is the most sensitive test for diagnosis.
- Among the patients who present with clinical signs of subdural hematoma, the trephination is the most specific test for the diagnosis.
Diagnostic results
The following findings on CT scan are suggestive for subdural hematoma:
- Hyperintense in comparison to gray matter
- Crescent shape
- As the hematoma ages, it starts to become isointense in comparison to brain gray matter
- It may cross falx cerebri
- It may cause midline shift
NOTE: The presence of blood on trephination is confirmatory for subdural hematoma.
Sequence of Diagnostic Studies
The various investigations must be performed in the following order:
- History and symptoms
- Physical examination
- Imaging
- trephination
Diagnostic Criteria
There are no established criteria for the diagnosis of subdural hematoma.