Imaging in chronic subdural hematoma

Abstract

Chronic subdural hematoma (CSDH) is a disease characterized by abnormal accumulation of blood products in the subdural space. Head trauma plays an important role in its etiology. The incidence of CSDH is increasing in advanced age, male gender, and in those with coagulopathies. CSDH has a clinical presentation ranging from being asymptomatic to causing coma. While surgical options are used in symptomatic patients, observation with medical treatment is an option in asymptomatic cases. The first imaging study in a simple radiologically uncomplicated CSDH evaluation is a non-contrast computed tomography (CT) scan. Contrast-enhanced CT or magnetic resonance imaging is very useful in evaluating complicated cases. Since the transformation from an acute hematoma is paramount in its pathophysiology, it is important to review previous imaging, if available, to obtain a detailed clinical history, to develop a differential diagnosis, and to avoid radiological pitfalls. Radiological imaging provides useful information for guiding treatment, posttreatment follow-up and to determine prognosis as well as to confirm the diagnosis of CSDH. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021. All rights reserved.