Subdural Hematoma

When you suffer a head injury, it can result in a subdural hematoma. This is when a pocket of blood collects in between the brain and the skull. It can cause pressure to build on the brain and can be fatal if left untreated. Most of the time, subdural hematoma recovery happens on its own. In some cases, they need to be drained surgically to relieve pressure.

What Is Subdural Hematoma?

A subdural hematoma occurs when there is an injury to the head that causes bleeding. The blood collects in the spaces between the “dura” hence the name “subdural” hematoma.

The blood collects in between the skull and dura outside of the brain. While this is not an injury to the actual brain tissue, the injury causing the bleeding can push up against the brain. The pressure on the brain can become very high and cause you to lose consciousness. If left untreated, it can be fatal.

Types of Subdural Hematoma

There are a few different types of subdural hematoma depending on the stage:

Acute typeThis is when the hematoma forms right after a head injury. These are caused by falls, physical assault to the head, or a car accident.

Sub-acute type – The hematoma may be delayed and symptoms not present. This is known as a “sub-acute” hematoma and may come on within the first week after a head injury. They can even appear up to weeks later.

Chronic type – These typetakes around two or three weeks to appear. This often happens when the elderly bump their head even slightly and over time and the bleeding can build up slowly.

What Are the Symptoms of Subdural Hematoma?

The symptoms of a subdural hematoma refer both to bleeding on the brain and a contusion to the head. If you or someone you know suffers a head injury, watch for these signs:

  • Loss of consciousness after a bump to the head
  • Coma
  • Excessive sleepiness
  • Confusion at time of injury or days later
  • Seizure
  • Headache
  • Apathy/withdrawn
  • Weakness
  • Nausea/vomiting
  • Dizzy
  • Behavior changes

The symptoms of subdural hematoma may vary from person to person. The factors include the age of the person, the amount of bleeding, and other medical issues.

When to Seek Emergency Help:

A head injury that was traumatic needs to have emergency medical attention. If the patient is conscious, take them to the nearest emergency room. If the person is unconscious, call 911.

What Are the Causes of Subdural Hematoma?

A head injury is the most common cause of acute subdural hematoma. This happens with a car accident, fall or other serious blow to the head. This can break open the blood vessels outside of the brain and cause bleeding. It is more common in people that have bleeding disorders or people that take medications to thin the blood. Even bumping the head slightly can cause these vessels to rupture and bleed.

When a subdural hematoma is chronic, the injury may have happened in the previous days or weeks, but only caused a small rupture to the blood vessels. This causes a small leak that builds up over time. The symptoms appear much later than the injury. This is common in older people because their brain and dura contain very vulnerable blood vessels that take longer to heal.

The last cause is very uncommon, but a spinal tap can sometimes cause a subdural hematoma.

How Is Subdural Hematoma Diagnosed?

Diagnosing a subdural hematoma needs imaging studies to see changes inside the skull. This is done with either a magnetic resonance imaging (MRI) or a computed tomography (CT) scan. They can see the actual blood vessels, the area of bleeding/swelling, and the condition of the brain.

What Are the Treatments for Subdural Hematoma?

Drilling - If you have an acute subdural hematoma and life threatening symptoms, it needs to be treated with surgical intervention. The swelling of the hematoma can increase the pressure on the brain, so to decrease the pressure the surgeon will need to place several small holes into the skull. This procedure may have to be done a few times until the pressure shows a steady decline.

Craniotomy - Another type of surgery, called craniotomy, can help to completely remove the hematoma. A part of the skull is taken off and the hematoma taken out via suction. The piece of skull bone is left off to relieve pressure on the brain. This will also allow for the surgeon to go back in and drain again more easily.

Burr Holes - Burr holes can be used to relieve pressure from small subdural hematomas. Several small holes will be drilled into the skull and the surgeon can put in drainage tubing. The hematoma can drain itself through the tubes.

Medications – The first line is usually corticosteroid medications that can help to relieve the inflammation from the injury and relieve pressure. Since any brain injury can cause seizures, the doctor may use anti-seizure drugs to prevent further injury from seizures.

Long-Term Outlook of Subdural Hematoma

An acute or even a chronic subdural hematoma can result in death or permanent disability. The older the person, the higher the risks with this type of injury. Here is the prognosis according to age:

  • Age under 40, there is 20% risk of death
  • Age 40 to 80, there is 65% risk of death
  • Age 80 or older, there is 88% risk of death

An acute subdural hematoma has a very long recovery period. This depends on how bad the head trauma was. If death does not occur from the initial injury or the hematoma, there is a possibility of permanent damage, persistent vegetative state or even coma.

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