Complications
Various neurological deficits may result from the haematoma or its sequelae, including increased intracranial pressure. Recovery is of variable degree and time course.[3]
Coma can result from the head injury itself or from treatment of subdural haematoma.[3]
Large-volume subdural haematoma (SDHs) with significant midline shift or brain swelling after their removal may result in direct compression of anterior and posterior cerebral arteries, causing ischaemia and/or infarction. SDHs that occur in association with significant subarachnoid haemorrhage may result in stroke from vasospasm. An increased risk of ischaemic stroke, in the 4 weeks after non-traumatic SDH, may be due to interruption of antithrombotic therapy after SDH diagnosis.[186]
Infection rates have been quoted to be 1% to 2%.[191]
Patients with trauma-induced and non-trauma-related subdural haematoma (SDH) are at increased risk of seizures.[134] Up to 24% of patients with traumatic SDHs develop clinical seizures or epileptiform changes on electroencephalography either on presentation or post-operatively.[192] If the patient has seizures within the first week and has a severe brain injury, the likelihood is higher that they will have seizures beyond the first week. It is recommended that the patient continue receiving an anticonvulsant for at least 7 days after injury.[143][193][194]
Occurrence of seizures after this time frame may necessitate further anticonvulsant treatment and/or consultation with a neurologist.
Blood can re-accumulate in the subdural space acutely after an evacuation procedure or may appear in a delayed fashion, presenting as a subacute or chronic SDH.
Meticulous attention must be paid to correcting any pre-existing or post-operative coagulopathy.[195] Frontal drainage after burr hole craniotomy has been shown to reduce risk of recurrence without increasing the risk of infection.[196]
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