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Age determination of subdural hematomas with CT and MRI: a systematic review.
Differentiating extradural EDH from subdural SDH hemorrhage in the head is usually straightforward, but occasionally it can be challenging. SDHs are more common and there are a few distinguishing features which are usually reliable. The typical presentation is of a young patient involved in a head strike either during sport or a result of a motor vehicle accident who may or may not lose consciousness transiently. Following the injury they regain a normal level of consciousness lucid interval , but usually have an ongoing and often severe headache. Over the next few hours they gradually lose consciousness. In adults SDHs are due to falls and there may not be a clear history of trauma. In young children, non accidental injury is a significant cause. The patients level of consciousness gradually decreases with increasing mass effect and confusion is often encountered in the elderly. Almost always arterial explaining the progressive growth of the hematoma.
Septa within the hematoma cavity are common, especially in the mixed density chronic subdural hematomas CSHs. We retrospectively examined the medical records and MRIs of 64 consecutive patients. MRI was selected to find any organic causes of neurologic symptoms. We classified the CSHs into septated or non-septated group, since classification of the septa was frequently obscure. They were more common in the over years-old group. Unknown causes were more common in the septated group, which implies they might suffer from multiple traumas.