What are the key clinical features that suggest a diagnosis of subdural haematoma in an adult patient?

Key clinical features suggesting a diagnosis of subdural haematoma in an adult patient include:

• History of head injury, which may be recent or remote, often with a variable time interval before symptom onset.
• Altered level of consciousness ranging from confusion to coma, reflecting brain dysfunction due to mass effect or raised intracranial pressure.
• Focal neurological deficits such as unilateral weakness, sensory changes, or speech disturbances, indicating localized brain compression.
• Headache, which may be progressive and persistent, often worsening over days to weeks in chronic cases.
• Neuropsychiatric symptoms including emotional lability, irritability, depression, anxiety, or cognitive changes such as memory impairment and confusion.
• Seizures may occur, sometimes as an initial presentation.
• Signs of raised intracranial pressure such as nausea, vomiting, and papilloedema may be present in more advanced cases.

These features reflect the pathophysiology of subdural haematoma as a collection of blood between the dura and arachnoid mater causing brain compression and dysfunction. The clinical presentation can be acute, subacute, or chronic, with chronic subdural haematomas often presenting insidiously with neuropsychiatric and cognitive symptoms that can mimic other conditions (Machulda and Haut, 2000). The UK NICE guideline on head injury emphasizes the importance of altered brain function signs, including reduced consciousness, focal neurological signs, and seizures, as indicators for urgent imaging and specialist referral ¹. Additionally, emotional and behavioural changes such as irritability and emotional lability are recognized features post-head injury that may suggest underlying intracranial pathology including subdural haematoma ¹.

In summary, the diagnosis of subdural haematoma should be suspected in adults presenting with a history of head trauma accompanied by any combination of altered consciousness, focal neurological deficits, headache, seizures, or neuropsychiatric symptoms. Prompt neuroimaging, typically CT head, is essential to confirm the diagnosis and guide management ¹ (Machulda and Haut, 2000; Lim et al., 2019).