An emergent computed tomography (CT) scan of the head needs to be performed when an acute

subdural hematoma is suspected. It should be obtained immediately after the patient is stabilized using
standard Advanced Trauma Life Support (ATLS) guidelines. CT scanning is also the initial imaging
modality of choice for chronic subdural hematoma.
The trauma team and neurosurgeon must determine quickly which lesions warrant immediate evacuation,
and CT is the imaging modality of choice to facilitate this decision. Modern CT devices can produce
appropriate images in about 5 minutes, and the scans are highly sensitive to acute blood. Although
magnetic resonance imaging (MRI) is superior for demonstrating the size of an acute subdural hematoma
and its effect on the brain, noncontrast head CT is the primary means of making a diagnosis and suffices
for immediate management purposes.
A worsening of the Glasgow Coma Scale by 2 or more points should prompt repeat imaging in
salvageable patients. A cervical spine radiograph series is important in evaluating the possibility of
concomitant cervical spine fracture.
Initial blood tests include the following:

Complete blood count

Hemoglobin or hematocrit
Coagulation profile
Basic metabolic panel
Type and screen/cross-match
In addition, drug and alcohol screenings may be important for correlating the neurologic examination with
the imaging studies.
Detection of electrolyte abnormalities is important because they can exacerbate brain injury and therefore
require correction in a timely manner. For example, hyponatremia (5-12% estimated incidence in patients
with head injury) can potentiate brain edema and cause seizures.