Subtle subdural hemorrhage and frontal contusion in trauma patient


Subdural hemorrhage is a collection of blood in between the dura mater and the arachnoid mater of the brain. In young adults, subdural hemorrhage is typically caused by traumatic head injury associated with motor vehicle accidents. It is said to have an incidence of 12-29% of patients presenting with severe traumatic brain injury1

Patients with subdural hemorrhage can often present with neurological signs, such as a decreased conscious state or pupillary changes.

Treatment of subdural hematomas depends on the chronicity (acute vs chronic) as well as the degree of mass effect that is being produced. Surgical intervention in acute subdural hematoma can be dictated by the following guidelines2:

  1. SDH thickness greater than 10mm
  2. Midline shift greater than 5mm
  3. Neurological changes - GCS drop by 2 or more points; assymetric pupils; intracranial pressure > 20mm Hg

In this case, this small subdural hemorrhage did not have any midline shift, and was not associated with any neuorological changes. The hemorrhage was managed conservatively.

Case contributed by A/Prof. Pramit Phal.