Traumatic Parafalcine Subdural Hematoma: A Clinically Benign Finding

J Surg Res. 2020 May:249:99-103. doi: 10.1016/j.jss.2019.12.019. Epub 2020 Jan 8.


Background: Guidelines for management of intracranial hemorrhage do not account for bleed location. We hypothesize that parafalcine subdural hematoma (SDH), as compared to convexity SDH, is a distinct clinical entity and these patients do not benefit from critical care monitoring or repeat imaging.

Methods: We identified patients presenting to a single level I trauma center with isolated head injuries from February 2016 to August 2017. We identified 88 patients with isolated blunt traumatic parafalcine SDH and 228 with convexity SDH.

Results: Demographics, comorbidities, and use of antiplatelet and anticoagulant agents were similar between the groups. As compared to patients with convexity SDH, patients with parafalcine SDH had a significantly lower incidence of radiographic progression, and had no cases of neurologic deterioration, neurosurgical intervention, or mortality (all P < 0.005). Compared to patients admitted to the intensive care unit, patients with parafalcine SDH admitted to the floor had a shorter length of stay (2.0 ± 1.6 versus 3.8 ± 2.9 d, P < 0.005) with no difference in outcomes.

Conclusions: Patients presenting with a parafalcine SDH are a distinct and relatively benign clinical entity as compared to convexity SDH and do not benefit from repeat imaging or intensive care unit admission.

Keywords: ICH; Interhemispheric; Parafalcine; SDH; TBI.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Disease Progression
  • Female
  • Glasgow Coma Scale
  • Head Injuries, Closed / complications*
  • Hematoma, Subdural / diagnosis*
  • Hematoma, Subdural / etiology
  • Hematoma, Subdural / mortality
  • Humans
  • Intensive Care Units / standards
  • Intensive Care Units / statistics & numerical data
  • Intracranial Hemorrhage, Traumatic / diagnosis*
  • Intracranial Hemorrhage, Traumatic / etiology
  • Intracranial Hemorrhage, Traumatic / mortality
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Neuroimaging / standards
  • Neuroimaging / statistics & numerical data
  • Neurosurgical Procedures / statistics & numerical data*
  • Registries / statistics & numerical data
  • Retrospective Studies
  • Trauma Centers / standards
  • Trauma Centers / statistics & numerical data