Journal article
Management of Subdural Hematomas: Part I. Medical Management of Subdural Hematomas
Current treatment options in neurology, v 20(8), pp 28-28
01 Aug 2018
PMID: 29936548
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Subdural hematomas (SDH) represent common neurosurgical problem associated with significant morbidity, mortality, and high recurrence rates. SDH incidence increases with age; numbers of patients affected by SDH continue to rise with our aging population and increasing number of people taking antiplatelet agents or anticoagulation. Medical and surgical SDH management remains a subject of investigation.
Initial management of patients with concern for altered mental status with or without trauma starts with Emergency Neurological Life Support (ENLS) guidelines, with a focus on maintaining ICP < 22 mmHg, CPP > 60 mmHg, MAP 80-110 mmHg, and PaO2 > 60 mmHg, followed by rapid sequence intubation if necessary, and expedited acquisition of imaging to identify a space-occupying lesion. Patients are administered anti-seizure medications, and their antiplatelet medications or anticoagulation may be reversed if neurosurgical interventions are anticipated, or until hemorrhage is stabilized on imaging.
Medical SDH care focuses on (a) management of intracranial hypertension; (b) maintenance of adequate cerebral perfusion; (c) seizure prevention and treatment; (d) maintenance of normothermia, eucarbia, euglycemia, and euvolemia; and (e) early initiation of enteral feeding, mobilization, and physical therapy. Post-operatively, SDH patients require ICU level care and are co-managed by neurointensivists with expertise in treating increased intracranial pressure, seizures, and status epilepticus, as well as medical complications of critical illness. Here, we review various aspects of medical management with a brief overview of pertinent literature and clinical trials for patients diagnosed with SDH.
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Details
- Title
- Management of Subdural Hematomas: Part I. Medical Management of Subdural Hematomas
- Creators
- Elena I. Fomchenko - Yale UniversityEmily J. Gilmore - Yale UniversityCharles C. Matouk - Yale UniversityJason L. Gerrard - Yale UniversityKevin N. Sheth - Yale University
- Publication Details
- Current treatment options in neurology, v 20(8), pp 28-28
- Publisher
- Current Medicine Group
- Number of pages
- 12
- Grant note
- Yale Neurosurgery Yale Department of Clinical Neurosciences
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurology
- Web of Science ID
- WOS:000436155800003
- Scopus ID
- 2-s2.0-85050462173
- Other Identifier
- 991022004962804721
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Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Clinical Neurology