Traumatic Subdural Hematoma
Traumatic subdural hematoma is a definite clinical entity that has been given considerable attention in the medical literature since Virchow’s classic description1 of “hematomas of the dura mater” in 1857. The lesion consists of an encysted collection of blood, situated between the dura and the arachnoid membranes, usually over the convexity of the cerebral hemisphere. It is my aim to sketch briefly the clinical and pathologic aspects of this interesting lesion and to dwell particularly on the reason for its delayed clinical manifestations.
The majority of published reports of cases of traumatic subdural hematoma are similar in one respect, that is, in the occurrence of a latent interval between the reception of trauma and the onset of pressure symptoms. The cranial trauma that was responsible may have been severe or so trivial as to be readily forgotten. In many instances a history of trauma that had been denied previously has been obtained after operative verification of the lesion has led to closer questioning of the patient or his relatives. The latent interval may vary from a few hours to many months or even years, and during this period the symptoms may be slight or even entirely absent.
The onset of symptoms may be insidious or rapidly progressive. The most common symptom is headache, occasionally associated with vomiting. Mental disturbances occur more frequently in the presence of this condition than in the case of any other space-filling intracranial lesion. Inequality of the pupils, papilledema and pyramidal tract signs are frequently present. . .