![]() Recurrent subdural hematomas that have a fluid consistency may be treated with a subdural-peritoneal shunt. First-line management of chronic subdural hematoma with the subdural evacuating port system: institutional experience and predictors of outcomes. Hoffman H, Ziechmann R, Beutler T, et al. Newer methods of evacuation include subdural evacuating port systems. Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. Evacuation of chronic subdural hematomas with the Twist-Drill technique: Results of a randomized prospective study comparing 48-h and 96-h drainage duration. Ibrahim I, Maarrawi J, Jouanneau E, et al. Surgical management may be frontotemporoparietal craniotomy, burr hole craniotomy with irrigation, or twist-drill craniotomy with drain placement. Surgical intervention is indicated for hematomas that meet many of the same surgical criteria as acute hematomas, with postoperative recurrence included on the list. It is important to follow traditional traumatic brain injury principles, including maintaining a cerebral perfusion pressure of 60 to 70 mmHg and ICP 10 mm or a midline shift >5 mm with any GCSĬhronic subdural hematomas may be managed in a variety of ways.Ĭonservative therapy is reserved for hematomas that meet the same criteria as acute hematomas, as described above. In patients with increased intracranial pressure (ICP), a standard protocol is used for management. Management of elevated intracranial pressure ![]() Review of recently approved alternatives to anticoagulation with warfarin for emergency clinicians. Stroke prevention in atrial fibrillation: a clinical perspective on trials of the novel oral anticoagulants. Guideline for reversal of antithrombotics in intracranial hemorrhage: a statement for healthcare professionals from the Neurocritical Care Society and Society of Critical Care Medicine. Frontera JA, Lewin JJ 3rd, Rabinstein AA, et al. ![]() When treating subdural hematomas in patients on DOACs, providers should be encouraged to consult with their hematology colleagues for potential reversal options. DOACs have several advantages over warfarin, including less risk of life-threatening hemorrhages, which is why their use is increasing. Examples of these direct oral anticoagulants (DOACs) include dabigatran, rivaroxaban, apixaban, and edoxaban. Providers managing subdural hematomas should also be aware of newer anticoagulants which target either thrombin or factor Xa. All patients require serial prothrombin time, partial thromboplastin time, international normalized ratio, and platelet and fibrinogen levels followed. 2008 Feb 150(2):165-75 discussion 175.Īll patients on anticoagulation should have their antiplatelet or anticoagulant agent stopped and/or reversed. Coagulation disorders after traumatic brain injury. Harhangi BS, Kompanje EJ, Leebeek FW, et al. ![]() Defibrination after brain-tissue destruction: A serious complication of head injury. Goodnight SH, Kenoyer G, Rapaport SI, et al. Coagulation abnormalities in patients with head injury. Many patients with severe head injury present with coagulopathy and require normalization of their coagulation profile. Subacute hematomas can be treated in the same way as chronic hematomas acute-on-chronic hematomas are usually treated in the same way as acute subdural hematomas. Generally, the most important criteria for determining management of acute subdural hematomas are neurologic signs/symptoms and radiographic appearance. Neurosurgeons use many different strategies for managing acute and chronic subdural hematomas.
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