Subdural hematoma symptoms typically present with which pattern?

• A. Progression over hours to days with headache, confusion, vomiting
• B. Thunderclap headache with neck stiffness
• C. Immediate coma after injury
• D. No symptoms initially

Answer: (A)

Subdural hematomas develop from tearing of bridging veins, so blood accumulates slowly between the dura and arachnoid. Because the bleed is venous and progressive, symptoms typically evolve over hours to days as intracranial pressure rises. The classic presentation includes a worsening headache, confusion or cognitive changes, and vomiting, with potential development of lethargy or focal deficits as the condition progresses. This gradual pattern is more characteristic than a sudden thunderclap head‑ache with neck stiffness (seen with subarachnoid hemorrhage) or an immediate coma after injury (which suggests a more rapid, large intracranial bleed). In some people, especially older adults with brain atrophy, the onset can be even more subtle, but the hallmark is a progressive cluster of symptoms over time.