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Management of Subdural Hematomas: Part I. Medical Management of Subdural Hematomas

Elena I Fomchenko1, Emily J Gilmore2,3, Charles C Matouk4

  • 1Department of Neurosurgery, Yale University, 20 York St, New Haven, CT, USA. elena.fomchenko@yale.edu.

Current Treatment Options in Neurology
|June 25, 2018
PubMed

Insights

Subdural hematomas (SDH) are a growing neurosurgical concern. This review details current medical management strategies for SDH, focusing on intracranial pressure, cerebral perfusion, and seizure control.

Area of Science:

  • Neurosurgery
  • Neurology
  • Critical Care Medicine

Background:

  • Subdural hematomas (SDH) pose significant neurosurgical challenges, marked by high morbidity, mortality, and recurrence rates.
  • Increasing incidence is linked to an aging population and wider use of antiplatelet/anticoagulation therapies.
  • Optimal medical and surgical management of SDH remains an active area of research.

Purpose of the Study:

  • To review current medical management strategies for subdural hematomas (SDH).
  • To provide an overview of recent literature and clinical trials concerning SDH care.
  • To highlight key aspects of managing patients with SDH.

Main Methods:

  • Review of Emergency Neurological Life Support (ENLS) guidelines for initial patient stabilization.
  • Analysis of medical management principles including intracranial pressure (ICP) and cerebral perfusion pressure (CPP) maintenance.
  • Examination of post-operative care and neurocritical care interventions for SDH patients.

Main Results:

  • Initial management emphasizes maintaining critical physiological parameters (ICP, CPP, MAP, PaO2) and rapid diagnostic imaging.
  • Medical care focuses on managing intracranial hypertension, ensuring adequate cerebral perfusion, seizure prevention, and supportive measures.
  • Post-operative care involves intensive care unit (ICU) management by neurointensivists, addressing complications like increased ICP and seizures.

Conclusions:

  • Effective SDH management requires a multidisciplinary approach, integrating emergency stabilization with comprehensive medical and critical care.
  • Continued research into optimal treatment protocols is essential given the rising prevalence of SDH.
  • Adherence to established guidelines and prompt intervention are crucial for improving outcomes in SDH patients.
Abstract

Keywords:
Medical managementNeuro-critical careSubdural hematoma

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