Subdural hematoma

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The diagnosis of subdural hematoma (SDH) is often difficult, delayed, or not determined. A high mortality and serious morbidity are characteristic of the condition. Collected experiences of medical and neurologic services with patients harboring SDH are meager, despite the relatively large number of patients with SDH admitted to such services.1, 2 An analysis of 10 years of medical and neurologic interaction with patients having SDH was made in an attempt to identify demographic, historical, physical, and diagnostic features in patients subsequently found to have SDH and to report the outcome of the illness. Consecutive cases of SDH diagnosed in a 10-year period were collected from medical and autopsy records and analyzed according to the Statistical Package for Social Sciences.3 During the study period, 53 patients were admitted to medical or neurologic services and 49 patients were admitted to surgical services. Thirteen additional patients were found to have significant SDH at autopsy. Significance in this instance was defined as the patient under study having at least one of the following findings: (1) appropriate clinical signs during life, (2) evidence of cerebral compartmental shifts, or (3) secondary midbrain hemorrhages consistent with the effects of increased intracranial pressure.

Nine of the 13 patients in the autopsy group in whom SDH was not diagnosed during life had been originally admitted to medical or neurologic services. Although generally thought of as a surgical disease, more than half of all patients with SDH were admitted to medical or neurologic services initially.

The mean age of patients . . .



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