Definition

What is subdural hematoma?

A subdural hematoma is a collection of blood outside the brain. Subdural hematomas are usually caused by severe head injuries. The bleeding and increased pressure on the brain from a subdural hematoma can be life-threatening. Some subdural hematomas stop and resolve spontaneously; others require surgical drainage.

How common is subdural hematoma?

Subdural hematoma can affect patients at any age. It can be managed by reducing your risk factors. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of subdural hematoma?

Symptoms of subdural hematoma depend mostly on the rate of bleeding:

  • In head injuries with sudden, severe bleeding causing a subdural hematoma, a person may lose consciousness and become comatose immediately.
  • A person may appear normal for days after a head injury, but slowly become confused and then unconscious several days later. This results from a slower rate of bleeding, causing a slowly enlarging subdural hematoma.
  • In very slow-growing subdural hematomas, there may be no noticeable symptoms for more than two weeks after the bleeding starts.

Symptoms of subdural hematoma can include:

  • Headache
  • Confusion
  • Change in behavior
  • Dizziness
  • Nausea and vomiting
  • Lethargy or excessive drowsiness
  • Weakness
  • Apathy
  • Seizures

People may vary widely in their symptoms of subdural hematoma. Besides the size of the subdural hematoma, a person’s age and other medical conditions can affect the response to having a subdural hematoma.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes subdural hematoma?

Subdural hematoma is usually caused by a head injury, such as from a fall, motor vehicle collision, or an assault. The sudden blow to the head tears blood vessels that run along the surface of the brain. This is referred to as an acute subdural hematoma.

People with a bleeding disorder and people who take blood thinners are more likely to develop a subdural hematoma. A relatively minor head injury can cause subdural hematoma in people with a bleeding tendency.

In a chronic subdural hematoma, small veins on the outer surface of the brain may tear, causing bleeding in the subdural space. Symptoms may not be apparent for several days or weeks. Elderly people are at higher risk for chronic subdural hematoma because brain shrinkage causes these tiny veins to be more stretched and more vulnerable to tearing.

Risk factors

What increases my risk for subdural hematoma?

Infants

In the infant brain, subdural hematomaare caused by tearing of the bridging veins in the subdural space and may result in significant brain injury. Some subdural hematomaare due to physical abuse, so suspicion should be raised but subdural hematomashould not be assumed to be always due to this cause in children.

The so-called ‘shaken baby syndrome’ remains controversial and may have other potential aetiologies than ‘shaking’. It may also be seen in older children.

The elderly

Cerebral atrophy can occur in people over the age of 60, causing tension on the veins, which may also be weaker and more susceptible to injury as a consequence of age. Chronic subdural hematomais more common in this age group.

Those with alcoholism

Alcohol misuse leads to a risk of thrombocytopenia, prolonged bleeding times and blunt head trauma and is a risk factor for subdural hematoma. Alcoholism also causes cerebral atrophy which can put tension on the bridging veins.

People on anticoagulation treatment:

Anticoagulation treatment (including with aspirin or warfarin) is another risk factor.

 

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is subdural hematoma diagnosed?

People who come to medical attention after a head injury often undergo head imaging, usually with computed tomography (CT scan) or magnetic resonance imaging (MRI scan). These tests create images of the interior of the skull, usually detecting any subdural hematoma present. MRI is slightly superior to CT in detecting subdural hematoma, but CT is faster and more readily available.

Rarely, angiography may be used to diagnose subdural hematoma. During angiography (angiogram), a catheter is inserted through an artery in the groin and threaded into the arteries of he neck and brain. Special dye is then injected, and an X-ray screen shows blood flow through the arteries and veins.

How is subdural hematoma treated?

Treatment of subdural hematomas depends on their severity. Treatment can range from watchful waiting to brain surgery.

In small subdural hematomas with mild symptoms, doctors may recommend no specific treatment other than observation. Repeated head imaging tests are often performed to monitor whether the subdural hematoma is improving.

More severe or dangerous subdural hematomas require surgery to reduce the pressure on the brain. Surgeons can use various techniques to treat subdural hematomas:

  • Burr hole trephination. A hole is drilled in the skull over the area of the subdural hematoma, and the blood is suctioned out through the hole.
  • A larger section of the skull is removed, to allow better access to the subdural hematoma and reduce pressure. The removed skull is replaced shortly after the procedure.
  • A section of the skull is removed for an extended period of time, to allow the injured brain to expand and swell without permanent damage. Craniectomy is not often used to treat subdural hematoma.

Lifestyle changes & Home remedies

What are some lifestyle changes or home remedies that can help me manage subdural hematoma?

The following lifestyles and home remedies might help you cope with subdural hematoma:

  • Avoidance of over-anticoagulation in patients taking warfarin.
  • Avoidance of falls in older people, especially if on anticoagulants.
  • Treatment for alcoholism.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: July 18, 2017 | Last Modified: July 18, 2017

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