What are the CT Manifestations of Subdural and Epidural Hematomas?

There are significant differences between subdural and epidural hematomas, resulting in distinct CT manifestations. Subdural hematomas typically occur between the dura mater and arachnoid membrane, and can be classified as acute, chronic, or subacute. These hematomas can have significant impacts on health and require attention. It is crucial to distinguish subdural hematomas from epidural hematomas to avoid potential confusion that could lead to severe consequences and endanger patients' health.

1. What are the CT manifestations of subdural and epidural hematomas? Epidural hematomas and subdural hematomas are two of the most common types of craniocerebral trauma. Epidural hematomas appear on CT as a biconvex or fusiform high-density shadow beneath the inner table of the skull and outside the brain tissue, often accompanied by skull fractures but without significant cerebral edema. In contrast, subdural hematomas manifest as a crescent-shaped high-density shadow beneath the inner table of the skull and outside the cerebral cortex on CT. Skull fractures are uncommon, but subdural hematomas often coexist with cerebral contusions and lacerations, presenting as high-density hemorrhagic shadows within the brain tissue with more pronounced cerebral edema.

2. Precautions for epidural and subdural hematomas: Epidural and subdural hematomas are common types of craniocerebral injury. It is essential to immediately hospitalize and observe patients with suspected hematomas. If the hemorrhage volume is small, conservative treatment with medications such as hemostatic agents, blood circulation-promoting agents, and antiepileptic drugs may be sufficient. Close observation of patients' consciousness, pupils, and vital signs is crucial as subdural and epidural hematomas may enlarge in the early stages, potentially leading to coma or cerebral hernia formation, necessitating urgent craniotomy and hematoma evacuation. If the hematoma volume is large initially, craniotomy and hematoma evacuation should be performed as soon as possible to prevent prolonged cerebral hernia formation, brainstem dysfunction, and potential respiratory and cardiac arrest.

3. Treatment of epidural and subdural hematomas: Epidural and subdural hematomas are common neurosurgical conditions often resulting from craniocerebral injuries such as traffic accidents, falls from heights, and severe blows. The treatment approach is primarily determined by the hematoma volume. For small hematomas (less than 30ml in the cerebral hemisphere and less than 10ml in the cerebellar hemisphere), non-surgical conservative treatment with hemostasis, dehydration, antiepileptic drugs, and neuroprotective measures is recommended. The hematoma will gradually be absorbed over 3-4 weeks. However, for larger hematomas (greater than 30ml in the cerebral hemisphere and greater than 10ml in the cerebellar hemisphere), craniotomy and hematoma evacuation is necessary. Depending on the presence of cerebral hernia, craniectomy and decompression may also be required.