Subdural Hematoma vs Epidural Hematoma
Subdural Hematoma and Epidural Hematoma are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Subdural Hematoma vs Epidural Hematoma at a glance
- Subdural Hematoma: Bleeding between dura and arachnoid from torn bridging veins; crescent-shaped on CT.
- Epidural Hematoma: Arterial bleeding between skull and dura, classically from middle meningeal artery injury.
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Side-by-side comparison
| Feature | Subdural Hematoma | Epidural Hematoma |
|---|---|---|
| At a glance | Bleeding between dura and arachnoid from torn bridging veins; crescent-shaped on CT. | Arterial bleeding between skull and dura, classically from middle meningeal artery injury. |
| Classic presentation | Crescentic (concave/'moon-shaped') extra-axial collection on CT that crosses suture lines. Acute = hyperdense (white), subacute = isodense (may be subtle), chronic = hypodense (dark).; Acute SDH: history of significant trauma, immediate decreased consciousness, headache, vomiting; Chronic SDH: insidious onset over weeks-months of… | Lucid interval after temporal trauma + ipsilateral blown pupil + contralateral hemiparesis = uncal herniation from expanding EDH.; Head trauma with brief loss of consciousness; Classic 'lucid interval' (minutes to hours of normal mentation) followed by rapid neurologic deterioration in ~20-50%; Headache, vomiting, confusion progressing… |
| Workup / key labs | CBC, platelets, PT/INR, PTT — anticoagulation common in this population; BMP, LFTs; Type and screen if surgical intervention likely | CBC, platelets, PT/INR, PTT (rule out coagulopathy); BMP, type and screen, alcohol/toxicology if indicated |
| Imaging | Non-contrast head CT — first-line, identifies acute SDH easily; Subacute (isodense) SDH may be missed on CT; contrast or MRI helpful; MRI — most sensitive for small or chronic SDH and dating the bleed; Repeat CT in 6-24 h if patient deteriorates or has progressive symptoms | Non-contrast head CT — biconvex (lens-shaped) hyperdense collection limited by suture lines, often with adjacent skull fracture; CT brain windows + bone windows mandatory (fracture identification); CT angiography if vascular injury suspected (e.g., carotid dissection from skull base fracture); Cervical spine imaging — significant head… |
| First-line treatment | ABCs; intubate if GCS ≤8; Reverse anticoagulation: warfarin → 4-factor PCC + vitamin K 10 mg IV; DOACs → idarucizumab (dabigatran) or andexanet alfa / 4-factor PCC (factor Xa inhibitors); aspirin/clopidogrel — platelet transfusion controversial; BP control (avoid hypotension; target SBP <160 in acute SDH); Manage ICP: head of bed 30°,… | ABCs, cervical spine immobilization; Intubation if GCS ≤8 or airway compromise; Manage ICP: head of bed 30°, normocapnia (PaCO2 35-40), hypertonic saline (3%) or mannitol 1 g/kg if herniation signs; Reverse anticoagulation if present (PCC, vitamin K, FFP, idarucizumab, andexanet alfa); Emergency neurosurgical evacuation via craniotomy… |
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