Subdural hematoma physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Overview

Common physical examination findings of subdural hematoma include decreased level of consciousness, mental status abnormalities, abnormal gait, evidence of intracranial hypertension (papilledema), hemiparesis, and Parkinson like symptoms.

Physical Examination

Appearance of the Patient

• Patients with subdural hematoma usually appear normal.

Vital Signs

• Fever (in infected subdural hematoma)
• Vital signs in patients with subdural hematoma is usually normal.

Skin

• Skin examination of patients with subdural hematoma is usually normal.

HEENT

• Abnormalities of the head including evidence of head trauma
• Extra-ocular movements are normal
• Pupils reactive to light and commodation
• Ophthalmoscopic exam may be abnormal with findings of papilledema (in case of intracranial hypertension)

Neck

• Neck examination of patients with subdural hematoma is usually normal

Lungs

• Pulmonary examination of patients with subdural hematoma is usually normal.

Heart

• Cardiovascular examination of patients with subdural hematoma is usually normal.

Abdomen

• Abdominal examination of patients with subdural hematoma is usually normal.

Back

• Back examination of patients with subdural hematoma is usually normal.

Genitourinary

• Genitourinary examination of patients with subdural hematoma is usually normal.

Neuromuscular

• Patient is usually oriented to persons, place, and time
• Altered mental status may be present in acute SDH
• Glasgow coma scale may be abnormal in acute SDH
• Abnormal gait may be present
• Negative Trendelenburg sign
• Unilateral/bilateral tremor may be present in chronic SDH mimicking Parkinson disease
• Bradykinesia may be present in chronic SDH mimicking Parkinson disease
• Absent dysdiadochokinesia (palm tapping test)
• Unilateral/bilateral upper/lower extremity weakness may be present in chronic SDH
• Unilateral/bilateral sensory loss in the upper/lower extremity may be present in chronic SDH

Extremities

• Extremities examination of patients with subdural hematoma is usually normal.