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{{Subdural hematoma}}
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== Overview ==
There are 3 classification system for subdural hematoma. Subdural hematoma may be classified according to [[symptom]] onset and duration into 3 subtypes including acute, subacute, and chronic, according to midline shift and thickness into 4 subtypes, and based on imaging findings into 6 subtypes.


==Classification==
==Classification==
Subdural hematomas are divided into [[Acute (medical)|acute]], subacute, and [[chronic (medicine)|chronic]], depending on their speed of onset. Acute subdural hematomas that are due to trauma are the most lethal of all head injuries and have a high [[mortality rate]] if they are not rapidly treated with surgical decompression. 
There are 3 classification system for subdural hematoma:<ref name="pmid27428027">{{cite journal |vauthors=Alves JL, Santiago JG, Costa G, Mota Pinto A |title=A Standardized Classification for Subdural Hematomas- I |journal=Am J Forensic Med Pathol |volume=37 |issue=3 |pages=174–8 |date=September 2016 |pmid=27428027 |doi=10.1097/PAF.0000000000000255 |url=}}</ref><ref name="pmid8683845">{{cite journal |vauthors=Salahuddin T |title=Management of chronic subdural haematoma--a review of 23 cases |journal=J Pak Med Assoc |volume=46 |issue=2 |pages=32–3 |date=February 1996 |pmid=8683845 |doi= |url=}}</ref>
 
* Subdural hematoma may be classified according to [[symptom]] onset and duration into 3 subtypes: 
Acute bleeds develop after high speed acceleration or deceleration injuries and are increasingly severe with larger hematomas. They are most severe if associated with [[cerebral contusion]]s. Though much faster than chronic subdural bleeds, acute subdural bleeding is usually venous and therefore slower than the usually arterial bleeding of an [[epidural hemorrhage]]. Acute subdural bleeds have a high mortality rate, higher even than epidural hematomas and [[diffuse brain injury|diffuse brain injuries]], because the velocities necessary to cause them cause other severe injuries as well.<ref>Vinas F.C. and Pilitsis J. 2006. [http://www.emedicine.com/med/topic2888.htm Penetrating Head Trauma]. Emedicine.com.</ref> The mortality rate associated with acute subdural hematoma is around 60 to 80% <ref>Dawodu S. 2004. [http://www.emedicine.com/pmr/topic212.htm "Traumatic brain injury: Definition, epidemiology, pathophysiology"] Emedicine.com. Retrieved on [[August 7]], [[2007]].</ref>
** Acute: Develop less than 24 hours after [[head trauma]] (or other subdural hemorrhage causes) 
 
** Subacute: Develop between 1 to 10 days after [[head trauma]] (or other subdural hemorrhage causes) 
Chronic subdural bleeds develop over the period of days to weeks, often after minor head trauma, though such a cause is not identifiable in 50% of patients.<ref name="Downie">Downie A. 2001. [http://www.radiology.co.uk/srs-x/tutors/cttrauma/tutor.htm "Tutorial: CT in head trauma"].  Retrieved on [[August 7]], [[2007]].</ref> They may not be discovered until they present clinically months or years after a head injury.<ref name="Kushner98">
** Chronic: Develop weeks or months after [[head trauma]] (or other subdural hemorrhage causes). It can be further divided into 5 grads:
{{
*** Grade 0: Normal patient with no [[symptom]] 
cite journal |author=Kushner D |title=Mild Traumatic Brain Injury: Toward Understanding Manifestations and Treatment |journal=Archives of Internal Medicine |volume=158 |issue=15 |pages=1617–1624 |year=1998 |pmid=9701095 |doi= |url=http://archinte.highwire.org/cgi/content/full/158/15/1617
*** Grade 1: Patient has [[headache]] and mild or no [[neurological]] abnormalities but is [[alert]]  
}}
*** Grade 2: [[Decreased level of consciousness]] ([[drowsiness]]) with [[neurological]] abnormalities  
</ref> The bleeding from a chronic bleed is slow, probably from repeated minor bleeds, and usually stops by itself. <ref name="graham">Graham DI and Gennareli TA. Chapter 5, "Pathology of brain damage after head injury" Cooper P and Golfinos G. 2000. ''Head Injury'', 4th Ed. Morgan Hill, New York. </ref> Since these bleeds progress slowly, they present the chance to be stopped before they cause significant damage.  Small subdural hematomas, those less than a centimeter wide, have much better outcomes than acute subdural bleeds: in one study, only 22% of patients with chronic subdural bleeds had outcomes worse than "good" or "complete recovery". Chronic subdural hematomas are common in the elderly.
*** Grade 3: Sever [[Focal neurologic signs|focal neurological deficit]] and [[loss of consciousness]] but response to [[pain]] stimuli  
*** Grade 4: [[Coma]] with no response to [[pain]] stimuli  
* Subdural hematoma may be classified according to mid-line shift and thickness into 4 sub-types:
** Type A: Thickness ≤ 1cm, midline shift ≤ 5 cm
** Type B: Thickness > 1cm, midline shift ≤ 5 cm
** Type C: Thickness > 1cm, midline shift > 5 cm
** Type D: Thickness ≤ 1cm, midline shift > 5 cm
* Subdural hematoma may be classified according to [[imaging]] findings into 6 subtypes:
** Type 1: Hyperdense lesion, relatively homogeneous (describes acute subdural hemorrhages)
** Type 2: Isodense lesion, relatively homogeneous (describes subacute hemorrhages)
** Type 3: Hypodense, relatively homogeneous (describes chronic hemorrhages)
** Type 4: Isodense to hypodense, relatively heterogeneous (describes recent rebleeding)
** Type 5: Hypodense in its liquefied component, relatively heterogeneous; internal septations and loculations (higher risk for recurrence after surgical treatment)
** Type 6: [[Calcification|Calcified]] hyperdense, relatively homogeneous (describes subdural hemorrhage with [[Calcification|calcified]] component)


==References==
==References==

Latest revision as of 15:23, 12 June 2019

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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

There are 3 classification system for subdural hematoma. Subdural hematoma may be classified according to symptom onset and duration into 3 subtypes including acute, subacute, and chronic, according to midline shift and thickness into 4 subtypes, and based on imaging findings into 6 subtypes.

Classification

There are 3 classification system for subdural hematoma:[1][2]

  • Subdural hematoma may be classified according to symptom onset and duration into 3 subtypes:
  • Subdural hematoma may be classified according to mid-line shift and thickness into 4 sub-types:
    • Type A: Thickness ≤ 1cm, midline shift ≤ 5 cm
    • Type B: Thickness > 1cm, midline shift ≤ 5 cm
    • Type C: Thickness > 1cm, midline shift > 5 cm
    • Type D: Thickness ≤ 1cm, midline shift > 5 cm
  • Subdural hematoma may be classified according to imaging findings into 6 subtypes:
    • Type 1: Hyperdense lesion, relatively homogeneous (describes acute subdural hemorrhages)
    • Type 2: Isodense lesion, relatively homogeneous (describes subacute hemorrhages)
    • Type 3: Hypodense, relatively homogeneous (describes chronic hemorrhages)
    • Type 4: Isodense to hypodense, relatively heterogeneous (describes recent rebleeding)
    • Type 5: Hypodense in its liquefied component, relatively heterogeneous; internal septations and loculations (higher risk for recurrence after surgical treatment)
    • Type 6: Calcified hyperdense, relatively homogeneous (describes subdural hemorrhage with calcified component)

References

  1. ↑ Alves JL, Santiago JG, Costa G, Mota Pinto A (September 2016). "A Standardized Classification for Subdural Hematomas- I". Am J Forensic Med Pathol. 37 (3): 174–8. doi:10.1097/PAF.0000000000000255. PMID 27428027.
  2. ↑ Salahuddin T (February 1996). "Management of chronic subdural haematoma--a review of 23 cases". J Pak Med Assoc. 46 (2): 32–3. PMID 8683845.


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