Interhemispheric Subdural Hematoma Diagnosis and Management

Anatomical Differences and Classification

• Interhemispheric subdural hematoma (IHSDH) is a specific subtype of subdural hematoma that occurs in the space between the cerebral hemispheres along the falx cerebri, and standard subdural hematomas (SDHs) typically form over the convexity of the cerebral hemispheres 1
• Both are classified under the broader category of intracranial hemorrhage, which includes any form of bleeding within the intracranial vault 1

Diagnostic Considerations

• Computed tomography (CT) is the primary diagnostic tool for both IHSDH and conventional SDH, and accurate measurement of hemorrhage volume is critical for both prognosis and as an outcome measure 1

Etiology and Risk Factors

• Anticoagulation therapy is a common risk factor for IHSDHs 2

Clinical Pitfalls and Considerations

• Rapid reversal of anticoagulation is generally recommended for any patient with an intracranial hemorrhage, including IHSDH 2
• The risk of progressive bleeding is greater for all forms of intracranial hemorrhage when the baseline CT scan is performed early after injury and when coagulopathy is present 1