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The purpose of this study was to compare neuroendoscopy-assisted burr-hole evacuation with conventional burr . She had no focal neurologic deficits, and review of systems was negative except for headache, difficulty concentrating, and history of autosomal dominant polycystic kidney disease (ADPKD). Your surgeon will insert a catheter (a thin, flexible tube) into an artery in your thigh and thread it into the middle meningeal artery an artery that runs within the leathery covering of the brain, called the dura. Neurosurg. Cite this article. Some reasons for the decrease in mortality can be presented. When blood vessels under your skin are damaged and leak, the blood pools and results in a bruise. The 12th had recently been in a motor vehicle accident with a resulting subdural hygroma before riding the roller coaster. A CT scan combines a series of X-ray images taken from different angles and uses computer software to create cross-sectional images (slices) of the bones and brain tissue. It is a serious condition and emergency treatment may be needed. Focus https://doi.org/10.3171/2018.7.FOCUS18253 (2018). Our neurosurgeons have extensive training and experience in treating people with acute and chronic subdural hematomas. Pfister BJ, Chickola L, Smith DH. Stroke Spotlight: Hypercoagulable States in Ischemic Stroke, Challenge Case Report: Weakness and Wasting of the Left Foot With Pes Cavus, Fabian H. Rossi, MD; Welwin Liu, MD; Lourdes Benes Lima, MD; Alvaro G. Estevez, PhD; Umesh Sharma, MD; Sujatha Vuyyuru, MD; Maria Clara Franco, PhD; and Nina Tsakadze, MD, PhD, Prajwal Ciryam, MD, PhD; and Neeraj Badjatia, MD, MS, Todd J. Schwedt, MD; and David W. Dodick, MD. Advertising on our site helps support our mission. Its normally used to treat acute subdural hematomas but may be used to treat chronic subdural hematomas in some cases. The subdural hematoma will gently drain away within two to four days. Ellie Edlmann, Eric P. Thelin, Dex-CSDH trial collaborative and BNTRC collaborative. 2018;14(1):24-27. Neurosurg. Correspondence to 11. We have recently reported that the number of acute trauma craniotomies and later mortality are decreasing in Finland26. One month after drainage the patient continued to have headaches and a recurrent SDH was found (Figure 2(c)). See your healthcare provider if you have a head injury. For brain surgeries in the operating room, your neurosurgeon will put you to sleep under general anesthesia. endobj Your neurosurgeon will discuss your options and recommend a personalized treatment plan to ensure the best outcome for your health. : Co-designed the study, provided critical contribution to manuscript drafting, interpreted the results, revised the manuscript for intellectual content; J.O.T.S. 1. If you have a subdural hematoma, you have experienced a tear in a blood vessel, most commonly a vein, and blood is leaking out of the torn vessel into the space below the dura mater membrane layer. Charlson Comorbidity Index (CCI) score including AIDS/HIV, dementia, diabetes, chronic pulmonary disease, cerebrovascular disease, heart failure, hemi- or paraplegia, liver disease, malignancies, myocardial infarction, peptic ulcer disease, peripheral vascular disease, rheumatic disease, and renal disease was calculated as previously described18. : Conceived and designed the study, drafted the manuscript, interpreted the results, revised the manuscript for intellectual content; T.M.L. In themultivariable analysis, increased HR for 10-year case fatality was associated with theage groups of 55years or older (with the youngest age group as a reference), CCI score 1 or above (with CCI score of 0 as a reference), alcohol abuse and atrial fibrillation (Supplementary Table S1 and Supplementary Figure S2). 152:e313e320 (2021). Instances of delayed subdural hematoma after other causes of mild brain injury, however, have been reported in the literature. For this study, all patients aged 16years with neurosurgical or intensive care ward admission for traumatic and non-traumatic cSDH [International Classification of Diseases, 10th revision (ICD-10) diagnosis codes S06.5 or I62.0 as any diagnosis] and evacuation of subdural hematoma (Nordic Medico-Statistical Committee, NOMESCO codes AAD10 and/or AAD1217) from January 1, 2004, to December 31, 2017 were identified from the Care Register for Health Care. JAMA. Many people who are diagnosed with them dont even remember the exact event that caused the bleeding to start. The brain has three membrane layers or coverings (called meninges) that lie between the bony skull and your brain tissue. Usually, healthcare providers leave a drain in place for several days following surgery to allow the blood to continue draining. These people include: Subdural hematomas can be life-threatening. You can learn more about how we ensure our content is accurate and current by reading our. . Am J Med. Our findings are similar to the recent regional Finnish study6 and another nationwide Finnish study examining the association of dementia and mortality after operated cSDH24, but significantly lower than previously reported by Dumont et al. Other times, the injury was minor and may have occurred weeks before symptoms appeared. Intracranial subdural hematoma is a rare but well-documented complication . Prognosis of patients with operated chronic subdural hematoma, https://doi.org/10.1038/s41598-022-10992-5. However, he presented 2 months later with dizziness and unsteady gait. 5,10-12 The mechanism for the development of a delayed subdural hematoma is not fully understood, but it has been hypothesized that microvascular injury to the bridging vein wall can cause damage and necrotic changes to Chir. Judd Jones, an active 83-year-old business owner, was taking a shower when he slipped and fell and hit his head. endobj https://doi.org/10.1016/j.clineuro.2004.09.015 (2005). Healthcare providers treat larger hematomas with decompression surgery. In this procedure, your surgeon removes a part of your skull in order to access the clot or hematoma. Neurosurg. subdural hematoma brain tumors epidural hematoma hydrocephalus In many cases, burr holes are part of emergency procedures resulting from traumatic injuries and used to: relieve pressure on. She began feeling banged up after the first several roller-coaster rides and started to have a mild generalized headache. Reoperation was needed in 19.4% (n=1588) of patients. Upon literature review, we found numerous cases of serious neurologic injuries associated with riding roller coasters, including subarachnoid hemorrhage, traumatic migraine, arterial dissection, spinal cord injury, vitreous hemorrhage, and subdural hematoma. Roller coaster headaches revisited. : Curated the data, interpreted the results, revised the manuscript for intellectual content; V.K. We investigated case-fatality, excess fatality and need for reoperations following operated cSDH in a nationwide setting focusing on patient-related characteristics. 84132, Copyright 2023 University of Utah Health, Diagnosing Acute & Chronic Subdural Hematomas, Middle Meningeal Artery (MMA) Embolization, Make an Appointment with Our Neurosurgeons, Brain, Spine, & Nerve Treatment: Neurosciences, middle meningeal artery (MMA) embolization. Transient global amnesia isn't known to have any adverse side effects or do lasting harm. Article Weakness or numbness in any part of the body. A burr hole can be used to drain chronic subdural hematomas or acute ones that are smaller than 1 centimeter at the thickest point. Some people with this type of injury remain conscious, but most become drowsy or go into a coma from the moment of trauma. Roller coasters, G forces, and brain trauma: on the wrong track? Kitya, D. et al. Rauhala, M. et al. It usually requires immediate treatment. Many of these symptoms are caused by the swelling of the brain, known as cerebral edema . National Institute of Neurological Disorders and Stroke. Baseline fatality was calculated using gender-, age-, and calendar year-specific expected fatality rates in the corresponding total Finnish population provided by the Statistics Finland (www.stat.fi). Subdural hematoma following roller coaster ride while anticoagulated. One month later, computerized tomography revealed no recurrence of hematoma or mass effect . Of these women, only 1 had a prior known medical history (warfarin for antiphospholipid syndrome). (30%)14 and Miranda et al. You may be able to find out more about recovering from a brain injury and living with the after-effects through support groups and charities. J. Clin. Posti, J.P., Luoto, T.M., Sipil, J.O.T. A subdural hematoma is a collection of blood on your brain's surface under the skull. % The study was approved by the National Institute for Health and Welfare of Finland (THL, permission no: THL/2245/5.05.00/2019) and Statistics Finland (TK-53-484-20). 3. This is called a lucid interval. Some chronic subdural hematomas form with no apparent cause. A hematoma that gets bigger can cause gradual loss of consciousness and possibly death. In addition, we reviewed randomly selected patients with traumatic brain injury from one independent center and found a positive predictive value of 0.99 for brain injury diagnoses. If you have a subdural hematoma, you've experienced a tear in a blood vessel, most commonly a vein, and blood is leaking out of the torn vessel into the space below the dura mater membrane layer. Yes, a subdural hematoma can be a serious event. A subdural hematoma can be life-threatening. There is a possibility that some patients have not been included due to inconsistent ICD-10 and NOMESCO coding at the hospitals, which results in underestimation of the actual number of cSDH cases. If you or someone you know has any of the following symptoms after a head injury, call 911 or seek medical attention immediately. 1979;5(3):309-313. People with an acute subdural hematoma typically do not need treatment because the hematoma will break down in the body over time. Advertising revenue supports our not-for-profit mission. Scand. To obtain A subdural hematoma is a collection of blood on your brains surface under the skull. Neurologia Medico-Chirurgica. Other health issues may affect complications of either chronic or acute subdurals. Subdural hematomas with mass effect and midline shift are typically offered urgent surgical evacuation. Traumatic spinal subdural hematoma associated with intracranial subdural hematoma is a rare condition. As a non-surgical alternative, undergoing MMA embolization includesshorter hospital stays and a faster recovery. Baseline features were analyzed with independent samples t-test or Chi-squared test as appropriate. Chronic subdural hematomas are easier to treat than acute subdural hematomas. A subdural hematoma develops when bridging veins tear and leak blood. Again, higher CCI and older age had the highest HRs for case-fatality, which is also demonstrated in Fig. It takes about 30 minutes and typically requires light sedation, not general anesthesia that puts you to sleep. Neurology. This allows the body to break down the chronic subdural hematoma on its own within the following days and weeks. This period is called the lucid interval. Manickam, A., Marshman, L. A. G. & Johnston, R. Long-term survival after chronic subdural haematoma. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.merckmanuals.com/home/injuries-and-poisoning/head-injuries/intracranial-hematomas#v740124), (https://www.ncbi.nlm.nih.gov/books/NBK532970/). World Neurosurg. The use of MRI allows our neurosurgeons to recommend the treatment that is most likely to lead to long-term cure of the subduralhematoma with the lowest likelihood of returning in the future. We observed that higher age, but no other patient-related characteristics, were associated with increased risk for reoperation. Corticosteroids are often prescribed to reduce inflammation in the brain. Some people may feel better within a few weeks or months, while others may never make a full recovery even after many years. During the last two decades, however, perception of the nature of the disease has changed: cSDH has been associated with higher lingering mortality rates than previously reported6,12,14,15. Diseases can cause spontaneous leakage of blood into the brain. Sign up to receive new issue alerts and news updates from Practical Neurology. Acta Neurochirurgica (Wien). The results are given as the mean, median, percentage, hazard ratio (HR), or relative risk (RR) with a 95% confidence interval (CI), interquartile range (IQR), orstandard deviation (SD). https://doi.org/10.2176/nmc.ra.2016-0337 (2017). cSDH was long considered a condition that is trivial, benign in nature and easy to treat, most likely because of the straightforwardness of its surgical procedure15,19. Mrs. R was instructed to follow up with a neurologist if her headaches persisted or worsened. Association of antithrombotic drug use with subdural hematoma risk. 20. The management and prognosis of SDH will be discussed here. Multivariable Cox models included age, gender, CCI, alcohol abuse, atrial fibrillation, coagulopathy, hypertension, and study era which all were deemed clinically relevant for modelling. . Google Scholar. Hong SO, Kang DS, Kong MH, Jang SY, Kim JH, Song KY. Development of delayed acute subdural hematoma after mild traumatic brain injury: a case report. Acute subdural hematomas cause symptoms right away. On neurologic examination, 4 weeks after her headaches started, Mrs. R had no focal neurologic deficits or other findings. Your healthcare provider will ask you about your head injury (when and how it occurred, review your symptoms and other medical problems, review medications you are taking and ask about other lifestyle habits). Neurosurgical services are provided by all five university hospitals in Finland (Helsinki, Tampere, Turku, Kuopio and Oulu) of which all were included in the search. But it still has risks. Thank you for visiting nature.com. Evidence based diagnosis and management of chronic subdural hematoma: A review of the literature. We may need to treat some chronic subdural hematomas with brain surgery to drain the blood that has collected between the brain and the dura (outermost covering of the brain). Feghali, J., Yang, W. & Huang, J. The blood may collect in the brain tissue or underneath the skull, pressing on the brain. Of note, Mrs. R did not have a subdural hematoma on imaging 3 days after riding the roller coasters, but rather, she developed a delayed subdural hematoma, diagnosed 4 weeks after the roller-coaster ride. She went on to a full recovery and has no residual effects (Figure 4). The Canadian CT head rule for patients with minor head injury. Recovery after any severe brain injury is varied. Frailty has been associated with worse outcomes in other neurosurgical conditions22,23, and more recently, also in patients with operated cSDH11. You can use the Headway website to search for Headway services in your area. Google Scholar. Chronic subdural hematoma management: A systematic review and meta-analysis of 34,829 patients. We observed a significant association of comorbidities and case-fatality after operated cSDH, which is consistent with another recent study11. N. Am. Although the mechanism of injury from roller-coaster rides is not clearly understood, it is unlikely that Mrs. Rs subdural hematomas occurred purely by chance. If you're an older adult, even mild head trauma can cause a hematoma. & Raj, R. Mortality of older patients with dementia after surgery for chronic subdural hematoma: A nationwide study. In these cases, your neurosurgeon will numb up your skin with local anesthetic and make a small 1-inch incision (cut) in your scalp. 2006;295(19):2286-2296. & Martnez-Rumbo, R. Chronic subdural haematoma: Surgical treatment and outcome in 1000 cases. The latest study era (with the first study era as a reference) was associated with decreased HR for reoperation (Table 4). Merck Manual Professional Version. Epidemiological changes in acute traumatic brain injuries may also affect patients with cSDH on a larger scale, although this condition does not typically manifest in the acute phase. Ten-year case-fatality rate was 60.2%. Though recovery rates vary, 80 to 90 percent of patients experience significant brain function improvement after this procedure. 1994;37(6):1007-1010. Up to 20 percent of people with traumatic brain injuries are found to also have a subdural hematoma. The most common cause of an epidural hematoma is trauma. We do not endorse non-Cleveland Clinic products or services. Policy. 21. People who take anticoagulants (blood thinners) are at higher risk of complications. Recurrence rate may be as high as 70% over time, but modern estimated reoperation rates range between 10 and 20%3,4,5,7. 22. Shabani S, Nguyen HS, Doan N, Baisden JL. Sometimes surgery to drain the haematoma may need to be repeated. Whitehouse, K. J., Jeyaretna, D. S., Enki, D. G. & Whitfield, P. C. Head injury in the elderly: What are the outcomes of neurosurgical care?. A woman, age 34, with a medical history of ADPKD presented with acute-onset headaches after a day of riding roller coasters at an amusement park. Choose any area of neurology to see curated news, articles, case reports, and more on that topic. 8. A subdural hematoma describes a type of bleeding that causes irritation and pressure in the brain. Figure 2: Axial T2-fluid attenuated inversion recovery (FLAIR) MRI at 3 weeks shows bilateral frontoparietal subdural hemorrhages. Uno, M., Toi, H. & Hirai, S. Chronic subdural hematoma in elderly patients: Is this disease benign?. The body can absorb the small amount of blood over time, usually a few months. The current 30-day mortality rate of 4.2% is similar compared to the report by Rauhala and colleagues6. To our knowledge, this is the first case of subdural hematoma after a roller-coaster ride that presented in a delayed fashion. Bed rest, medications and observation may be all that is needed. Stiell IG, Wells GA, Vandemheen K, et al. Gelabert-Gonzlez, M., Iglesias-Pais, M., Garca-Allut, A. Am J Emerg Med. If the hematoma returns or remains in your brain, your doctor will discuss additional treatment options and next steps with you. 6. Although a roller-coaster ride may not have been sufficient to flag our patient for potential head trauma, an additional concern is her history of ADPKD, which is associated with a higher incidence of cerebral aneurysm (11.5% vs 7% in the general population).4 Mrs. R had negative findings of MR angiogram screening for cerebral aneurysm 5 years earlier. Med. In the meantime, to ensure continued support, we are displaying the site without styles You might develop signs and symptoms of an intracranial hematoma right after a head injury, or they may take weeks or longer to appear. Draining the blood relieves the pressure the blood buildup causes on the brain. JAMA J. A number of different healthcare professionals may be involved in your rehabilitation, depending on the specific problems you're experiencing: You might also benefit from some psychological support or therapy if you find it difficult adjusting to everyday life after a subdural haematoma. Neck or back pain. Surgical intervention (eg, bilateral burr holes) was considered but deferred because of improvement seen with steroid treatment. The three types of subdural hematomas are: All three types require medical attention as soon as signs and symptoms appear so that permanent brain damage can be prevented. Noncontrast CT and MRI are nearly 100% sensitive for identifying brain tumors.1, Primary headache disorders, including migraine, tension-type headache, and cluster headache, can be disabling, but are not life-threatening. The two latest study eras (20092013 and 20142018) were associated with decreased HR for case-fatality when the first study era (20042008) was used as a reference (Table 3). Box 52, 20521, Turku, Finland, Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland, Clinical Neurosciences, University of Turku, Turku, Finland, Department of Neurology, Siun Sote, North Karelia Central Hospital, Joensuu, Finland, Clinical Research Center, Turku University Hospital and University of Turku, Turku, Finland, Heart Centre and Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland, Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland, Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland, Administative Center, Hospital District of Southwest Finland, Turku, Finland, You can also search for this author in Will neuroimaging reveal a severe intracranial injury in this adult with minor head trauma? Approximately 20 to 30 percent of people regain full or partial brain function after having an acute subdural hematoma. Roldan-Valadez E, Facha MT, Martinez-Lopez M, Herrera-Mora P. Subdural hematoma in a teenager related to roller-coaster ride. Reoperation was performed on 1588 patients yielding a reoperation rate of 19.4% within one year. Her remaining course was notable only for a brief recurrence of headache upon completion of the steroid taper that was not severe enough to warrant resuming steroids. If you fall and hit your head or take a blow to the head in a car or bike accident, a sporting activity or have another type of head trauma, you are at risk for developing a subdural hematoma. A subdural hematoma is a common neurological condition that occurs after a head injury. In both genders, the highest case-fatality rates were observed in the oldest age group (Table 2). Find information and tools about neurological diseases to assist patients and caregivers. The blood may press against the brain and damage the tissue. Learn about symptoms, causes, treatment, and. But the outcomes after subdural hematomas can depend on age, the type of hematoma, and how quickly treatment is given. This can happen when the veins that bridge your child's brain to their dura are stretched too far, causing tears and bleeding. https://doi.org/10.3340/jkns.2012.52.3.234 (2012). Lukasiewicz AM, et al. The following day, he experienced the same numbness and tingling and started "speaking gibberish." These symptoms are also signs of other very serious health conditions. xXmo6nIEdHf~m*K-/bKbo3);;jxY8*"u%~qq^^ ~pDk=I#s{rF;PN];Nr8$s3#8mp*[Rse^~ A4ao=OGZlam`Uc-a;jJY.H-3m}bg7#/ wT Internet Explorer). One of the main findings is that although our reoperation rate can be considered high in the light of the current literature, the rate of reoperations is temporally decreasing in Finland. Neurol. Statistical significance was defined as a p value of <0.05. Due to the limitations of ICD-10 coding, we could not study these methods separately. The three types of subdural hematomas are: Acute. Mrs. R, age 34, presented to the emergency department with new-onset headache and difficulty focusing 3 days after spending a day at an amusement park, where she rode numerous roller coasters (total number of rides unknown). Posti J.P., Luoto T.M., Rautava P., Kyt V. (2021) Mortality after trauma craniotomy is decreasing in older adults: Nationwide population-based study. A systematic review. Subdural hematomas happen in a region called the subdural space. Ramachandran, R. & Hegde, T. Chronic subdural hematomas-causes of morbidity and mortality. Brain MRA showed no vascular abnormalities (Figure 3). In cases that need immediate treatment, patients will undergo traditional surgery in which a portion of the skull is removed, the outermost covering of the brain (the dura) is opened, and the acute subdural hematoma is evacuated. Frequently, in patients who have chronic (non-acute) subdural hematomas, they may not even remember experiencing a head injury in the past. People at increased risk of a subdural hematoma even though the head injury appears minor should also get immediate medical attention. All Cox-models were adjusted for surgical center by stratification. However, an intracranial hematoma is potentially life-threatening. A head injury is the most common cause of bleeding within the skull. This is a case involving the development of a delayed chronic subdural hematoma 2 months after a minor head injury with normal clinical neurological findings and brain computed tomography at . Subdural hematomas can be very serious and even deadly. N Engl J Med. Here are the types and symptoms to watch for. However, in some cases, following a head injury, an acute subdural hematoma will need to be treated immediately with surgery to relieve pressure on the brain. Neurol. Presse Med. Chronic subdural hematoma (cSDH) is the most common type of intracranial hemorrhage among older people1 and has become one of the most common neurosurgical diseases in the Western World due to the ageing population structure2,3. This type of bleeding usually happens after a head injury and can be either acute or chronic. Additionally, Dr. Luoto has received research grants from the Finnish Brain Foundation sr, the Emil Aaltonen Foundation sr, the Maire Taponen Foundation, the Science Fund of the City of Tampere, and the Finnish Medical Society Duodecim. Remarks on subdural hematoma and aphasia. A rapid overview summarizes the clinical features, evaluation, and management of SDH in adults ( table 1 ). Only one patient was reoperated later: on the 368th postoperative day. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. In the recent regional Finnish study, excess case-fatality was also observed in all age groups with higher risk for death in patients who were treated conservatively6. First, your healthcare provider will do a thorough physical and neurological exam. Bydon M (expert opinion). Sim, Y. W., Min, K. S., Lee, M. S., Kim, Y. G. & Kim, D. H. Recent changes in risk factors of chronic subdural hematoma. Our website services, content, and products are for informational purposes only. The mechanism of injury is unclear, as previously proposed theories about rotational acceleration and G-forces on roller coasters have been recently proven less likely with new studies on roller coaster head accelerations and thresholds for brain trauma. Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National, uclahealth.org/neurosurgery/acute-subdural-hematomas, journals.lww.com/annalsofsurgery/Abstract/2014/03000/Chronic_Subdural_Hematoma_Management__A_Systematic.7.aspx, uclahealth.org/neurosurgery/chronic-subdural-hematomas, thejns.org/view/journals/j-neurosurg/124/3/article-p760.xml, traumaticbraininjuryatoz.org/Moderate-to-Severe-TBI/Physical-Changes-Resulting-from-TBI/Subdural-Hematoma.aspx, nhs.uk/conditions/subdural-haematoma/symptoms/. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. Sci Rep 12, 7020 (2022). Chronic subdural haematoma: Modern management and emerging therapies. A low level of red blood cells can mean youve had significant blood loss. Rev. We also observed that in both 1-year and 10-year case-fatality models, atrial fibrillation and alcohol abuse were associated with increased risk for death. In a chronic subdural collection, blood leaks from the veins slowly over time, or a fast . Chronic subdural hematoma (CSDH) is the most common neurosurgical emergency in older people [1]. Headaches are a common physical complaint, but are not life-threatening in over 99% of cases.1 The challenge is to appropriately reassure a person with benign headaches without missing the rare life-threatening causes of headache. Article Complete resolution of SSDH was confirmed by MRI obtained 2-5 months later . Subdural hematoma (SDH) is a form of intracranial hemorrhage characterized by bleeding into the space between the dural and arachnoid membranes surrounding the brain. Updates in chronic subdural hematoma: Epidemiology, etiology, pathogenesis, treatment, and outcome. Dr. Kyt received funding from Finnish Governments Special Financial Transfer tied to academic research in Health Sciences, Finland. Kettaneh A, Biousse V, Bousser MG. [Neurological complications after roller coaster rides: an emerging new risk?]. Your neurosurgeon will either create small holes in your skull or remove a piece of your skull (which will be replaced after surgery) to insert a drain into the chronic subdural hematoma. Younger people have a higher chance of survival than older adults. Scranton RA, Evans RW, Baskin DS. http://www.merckmanuals.com/professional/injuries-poisoning/traumatic-brain-injury-tbi/traumatic-brain-injury. McIntyre, M. et al. https://doi.org/10.1038/nrneurol.2014.163 (2014). A CT scan can show a subdural haematoma. The following . https://doi.org/10.1007/s11060-017-2644-0 (2018). 15. Chronic subdural hematoma (cSDH), previously considered fairly benign and easy to treat, is now viewed a possible sign of incipient clinical decline. Subacute subdural hematoma in a 45-year-old woman with no significant past medical history after a roller coaster ride.