Subdural Hematoma

1 What is Subdural Hematoma?

Subdural hematoma is a condition characterized by bleeding between the layers of tissues in the brain.

Blood collects between the two layers outside the brain, the dura and arachnoid. This accumulation of blood outside the brain increases the pressure on the organ.

It is this increase in pressure that results in the symptoms of subdural hematoma.

If the pressure builds up to a very high level, it may lead to unconsciousness and death.

Those with bleeding disorders are more likely to develop subdural hematoma. Be alert and never neglect any form of head injury at any time.

2 Symptoms of subdural hematoma

Subdural hematoma symptoms depend mostly on the rate of bleeding.

Severe pain that leads to unconsciousness: The person can get exhausted and become comatose instantly.

The person may appear normal for days after a head injury, and subdural hematoma can occur gradually. It can be a confusing state and the person becomes unconscious several days later. This is caused by a slower rate of bleeding. The entire process can signal enlarging subdural hematoma.

In very slow-growing subdural hematomas, the symptoms are not noticeable at all in the beginning, but they can show 2 or 3 weeks after injury.

Symptoms of subdural hematoma include the following:

  • Headache – Mild but constant headache that makes the person feel weak
  • Confusion – Slight confusion about the injury and the persistent pain
  • Change in behavior – The person feels weak and tired, and may prefer to sit even when expected to be active
  • Dizziness – The person feels dizzy and exasperated after barely any activity
  • Nausea and vomiting – This can occur as a result of dizziness
  • Lethargy or excessive drowsiness – Inactive behavior and laziness
  • Weakness – Feeling out of energy
  • Apathy – The person has lost interest in any hobbies or activities
  • Seizure – The person may feel like their body is under attack

3 Causes

Subdural hematoma is typically caused by a head injury. The injury can be due to accidental fall, motor vehicle collision, or it can be a heavy blow to the head. The sudden strike can destroy the blood vessels around the head and over the surface of the brain. If this affects the brain partly, it is referred to as acute subdural hematoma.

Chronic subdural hematoma, which has smaller veins are on the outer surface of the brain, may tear by bleeding in the subdural space. Symptoms may not be noticeable for a number of days or weeks. Elderly people are at higher threat for chronic subdural hematoma because brain shrinkage damages the tiny veins and causes them to be more rigid and more susceptible to tearing.

4 Diagnosing subdural hematoma

Diagnosis of subdural hematoma is done when the person is addressed after his or her injury. The diagnosis undergoes head imaging, usually with computed tomography or CT scan, or magnetic resonance imaging (MRI scan). The tests conducted create images of the interior of the skull and the present position of parts inside the head. Subdural hematoma detection is usually done with MRI, which is considered superior to other methods, including CT scan. However, CT is faster and it can be available more readily. Because of this, it is also typically much cheaper for the patient than an MRI scan.

The latest technique of angiography may be used to diagnose a subdural hematoma by head injury. It involves inserting the catheter in the groin and threading it into the arteries of the neck and brain. During angiography (angiogram), a special dye is injected. The X-ray screen utilizes the dye to show the flow of arteries and veins which helps in detecting damage.

5 Subdural hematoma treatment

The treatment of subdural hematoma mainly depends on the severity of the injury. Treatment can range from minor bandaging, to watchfully waiting someone through recovery, to brain surgery.

If a person is having small subdural hematomas with mild symptoms, then the doctor may recommend simple treatment. Head imaging tests are performed to observe the status of the subdural hematoma to make sure that it is improving.
If the subdural hematomas are getting severe or dangerous, the situation might require surgery to minimize pressure on the brain.

Surgeons may use different techniques to treat the serious state of subdural hematomas and some of the techniques include:

  • Burr hole trephination: A hole is drilled in the skull around the damaged area of the subdural hematoma to suction out blood
  • Craniotomy: Part of the skull is removed to get better access to the subdural hematoma and reduce effect of the disease by minimizing the pressure around it. The removed skull can be placed back in its place after the surgery is over
  • Craniectomy: A section of the skull is taken out for a while and the injured brain is expanded without permanent damage. The type of surgery, like Craniectomy, is performed very rarely

Those who suffer seriously from severe subdural hematomas are often found seriously affected and mostly ill. Such patients require machine-supported breathing and most of time they live with life support.

6 Prevention

Subdural hematoma occurs due to the collection of blood outside the brain. This happens after head injuries of different forms, including minor head injuries to any major head injury. Therefore, safety is the best way to prevent hematoma from occurring. Wear protective headgear during intense physical activity and when riding bikes or motorcycles.

If you do suffer from a head injury, do not ignore it. No matter how minor it may seem, failure to provide immediate medical attention may result in fatal consequences.

7 Coping with subdural hematoma

The absolute most important thing is to closely follow the advice of your healthcare professional. Head trauma is not something that can be pushed aside. Following your doctor's instructions will guarantee the most efficient treatment possible for your unique condition. 

It may also take a while before you are able to partake in intense activities after treatment. Again, your doctor will let you know when it's appropriate to resume daily activity.

8 Risks and complications

A subdural hematoma is extremely dangerous if proper care is not taken. If you rush treatment, you risk further injury and possible lifelong complications. You cannot see inside your own head, so your treatment has to be closely and frequently monitored as to prevent complications.