THE PROBLEM of the clinical diagnosis of subdural hematoma is often considered so difficult that, at those clinics which have treated the greatest number of patients with craniocerebral trauma, diagnostic trephination has been commonplace.1-4 Among the difficulties encountered in appreciating the presence of this lesion are inadequate history, concomitant intrinsic brain damage, and toxic dehydration.1 Besides the sequellae of arteriosclerotic brain disease, i. e., senile dementia and generalized debility, the generalized brain atrophy that is a frequent accompaniment of senility5, 6 contributes another impediment to the clinical recognition or suspicion of this condition.
In elderly patients whose brains have shrunken in size and whose subarachnoid spaces are correspondingly widened, subdural hematomas find room for their bulk first at the expense of the extracerebral, dilated subarachnoid lakes, so that, proportionately for their size, it is only to a lesser degree and later than in younger persons that
Perlmutter I. Subdural Hematoma in Older Patients. JAMA. 1961;176(3):212–214. doi:10.1001/jama.1961.63040160001006