The subdural space is the potential space between the dura mater and the arachnoid mater of the brain and spinal cord. In normal physiology it does not exist as a true space, but it opens when blood or other fluid accumulates between the inner dural border cells and the outer arachnoid cells. Bridging veins crossing from the cerebral cortex to the dural sinuses traverse this potential space and are the source of subdural haematomas.
Subdural haematoma (SDH) is the most common traumatic intracranial haematoma, occurring when bridging veins rupture and blood accumulates in the subdural space. Acute SDH (within 72 hours) appears hyperdense on CT and requires urgent surgical evacuation for significant mass effect. Chronic SDH (over 3 weeks) from minor trauma especially in elderly patients on anticoagulants appears hypodense and may expand slowly. Bilateral chronic SDH produces bilateral convexity hypodensities. Hygroma refers to clear CSF in the subdural space from arachnoid tears. Subdural empyema from meningitis or sinusitis is a neurosurgical emergency.
Minor head trauma in elderly patients on anticoagulation tears bridging veins with slow accumulation of blood in the subdural space over weeks, producing progressive cognitive decline, headache, and hemiparesis; CT shows a crescentic hypodense collection with midline shift requiring burr hole evacuation and anticoagulation reversal.
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