Subdural hematoma is extra-cerebral accumulation of blood between the dura matter and the subarachnoid layer. Subdural hematoma can be associated with significant long-term morbidities and high rates of mortality. The mortality following subdural hematoma can be as high as 32%, and recurrence rates can reach 33%. Acute subdural hematoma is an emergency and requires prompt diagnosis using CT most of the time, and management requires surgery as well as reversal of anticoagulants. We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1985, through February 2017. The following search terms were used: emergency management of subdural hematoma, subdural hematoma, CT vs. MRI in diagnosis of subdural hematoma, treatment of subdural hematoma. In this review, our aim is to study the etiology of subdural hematoma and understand how it should be diagnosed and managed. Subdural hematoma are clinical emergencies that require immediate and rapid management to prevent significant morbidity and mortality. They can be grouped into acute, subacute, or chronic, with the acute type being the most dangerous and associated with the highest mortality rates. Subdural hematoma is diagnosed using CT or MRI imaging. Management of a patient with subdural hematoma includes resuscitation followed by control of the bleeding. Controlling intracranial pressure is an important factor for predicting the outcomes of subdural hematoma, and should thus be continuously monitored and corrected.

Background: Management of small aneurysms regularly poses a therapeutic problem and surgical treatment or coiling can be considered as therapeutic choices. In the current study, we reviewed our series of ruptured small cerebral aneurysm preserved surgically. Materials and Methods:A total of 53 consecutive patients with ruptured small aneurysm were surgically treated between November 2014 and November 2016. Data were retrospectively collected. Procedure-related death and complications were systematically reviewed. Clinical outcomes were evaluated utilizing the Modified Ranking Scale. Neuroradiological follow-up was performed to evaluate aneurysmal occlusion and recanalization rate. Results: The mean aneurysm size was 2 mm ± 0.7 mm. All the patients were operated and the aneurysm clipped. Clinical outcomes were as expected on the basis of the presenting Hunt and Hess grade. Generally, major and minor neurological deficit related to clipping were 5% and 3%, respectively. At the time of discharge, 85% of the patients presented with a favorable outcome, while 15% had poor clinical outcome. Aneurysm occlusion was achieved in all the cases. Neither recanalization nor re-aneurysmal rupture was observed in the clinical follow-up. Conclusion: Aneurysms, 3 mm in diameter or smaller, represent a therapeutic challenge. Given the proven role of microsurgery in small aneurysms and the perceived challenges with endovascular therapy, surgical clipping still can be considered an effective treatment modality in this setting.