Subdural Hematoma
Subdural Hematoma Overview
A subdural hematoma is a collection of blood on the surface of the brain, usually resulting from a serious head injury. An acute subdural hematoma is among the deadliest types of head injuries. The bleeding fills the brain area rapidly, which compresses brain tissue, leading to brain injury and possibly death.
Tiny veins between the brain’s surface and its outer covering (dura) stretch and tear, which allows the blood to collect. Even a minor head injury, especially in the elderly, can cause a subdural hematoma. That’s because the veins are already stretched due to brain shrinkage and are more easily injured. In some cases a subdural hematoma can be caused by a procedure such as a lumbar puncture.
There are three types of subdural hematomas. All are serious medical conditions that can result in permanent brain damage.
- Acute: This is the most dangerous type and is caused by a severe head injury and signs and symptoms appear almost immediately.
- Subacute: With this type it can take longer—even days or weeks after the injury—for symptoms to appear.
- Chronic: This subdural hematoma is characterized by slower bleeding that may not be associated with a head injury. Symptoms can take weeks to appear.
Symptoms
If you or someone you know has any of these symptoms listed below, or has sustained a head injury, seek medical help. Call 911 or get to an emergency room in case of seizures or loss of consciousness.
Any of the following subdural hematoma symptoms are possible, depending on the type of hematoma and how and where it is pressing on the brain:
- Problems with speaking and swallowing
- Problems with balance or walking
- Headache
- Seizures
- Confusion or lethargy
- Loss of consciousness
- Weakness or numbness in the face and limbs
- Vision problems
- Feeling of weakness
- Drowsiness
In infants, symptoms can include:
- Bulging of the “soft spots” (fontanelles) on the baby’s skull
- Feeding difficulties
- Seizures
- High-pitched crying
- Increase in head circumference
- Irritability
- Persistent vomiting
- Separated sutures (the areas where the growing skull bones join together)
Risk Factors
- The following are risk factors for developing subdural hematoma.
- Use of anticoagulant medications (including aspirin) to thin the blood
- Long-term abuse of alcohol
- Numerous falls
- Repeated head injury
- Age—being very young or very old
Subdural Hematoma Prevention
One of the ways to prevent a subdural hematoma is to protect yourself from head injuries by using proper safety equipment for work and recreation. Examples are hard hats, seat belts and bike or motorcycle helmets. Older adults should be cautious and try to improve balance and avoid falls.
Take steps to protect young children from head injuries children by:
- Using properly fitted car seats
- Blocking stairways
- Bolting heavy furniture or appliances to the wall to avoid tipping
- Keeping children from climbing on unsteady objects
- Adding padding to countertops and sharp table edges
Subdural Hematoma Diagnosis
Diagnosing bleeding inside the brain can be challenging because patients who have sustained a head injury often seem fine right after the injury. However, a loss of consciousness after an injury is generally believed to a result of a hemorrhage inside the skull.
Your physician will review symptoms, take a medical history and conduct physical and neurological exams. The doctor will be checking for problems with:
- Walking
- Balance
- Coordination
- Mental function
- Sensation
- Strength
Tools and Tests
Wellstar physicians use various diagnostic tools and tests to assess the possibility of a subdural hematoma.
- Computerized tomography (CT) uses X-rays linked to a computer to produce detailed scans of the brain. CT is the most common imaging scan for diagnosing subdural hematomas and other brain bleeding
- Magnetic resonance imaging (MRI) scan uses a large magnet and radio waves to take detailed images of the brain. It is especially useful for detecting smaller hematomas
Subdural Hematoma Treatment
Treatment varies according to the size and impact of the hematoma on the brain. Some small hematomas that are not producing symptoms do not need to be removed surgically. Your doctor may prescribe diuretic medication to help control brain swelling (edema) following a head injury. In other cases emergency surgery may be necessary to reduce pressure within the brain.
Surgery
Wellstar neurosurgeons offer the latest surgical treatments for subdural hematoma in the interventional suite at the Cerebrovascular and Endovascular Neurosurgery Program at Kennestone Hospital.
If you have been diagnosed with a subdural hematoma your neurosurgeon will fully explain the options and recommend the most appropriate surgery for your condition and health status. Choices include:
- Surgical drainage: This is a possibility when the blood is localized (in one area) and is not clotting excessively. The procedure involves cutting a small (burr) hole through the skull and using suction to remove the liquid.
- Craniotomy: This may be an option for a larger hematoma. In this procedure the neurosurgeon will temporarily remove a part of the bone from the skull to expose the brain and provide access to the hematoma and remove it.
Ongoing Care for Subdural Hematomas
Recovery from a subdural hematoma can take time and will vary depending on the type and location of head injury, the amount of collected blood and how quickly treatment is administered.
Possible complications can include brain damage, seizures, and persistent symptoms such as memory loss, dizziness, headache, amnesia, sleep problems, difficulty concentrating, weakness, numbness and speech problems. The prognosis for patients with subacute and chronic subdural hematomas is better than for those with acute conditions.
Rehabilitation
Patients being treated for a subdural hematoma may require outpatient rehabilitation. The goal is to regain function in speech, mobility and activities of daily living such as eating, bathing, toileting and dressing.
Physical therapists, occupational therapists and speech therapists work with patients and their doctors to develop individualized treatment plans that address:
- Pain management
- Regaining independence with daily activities
- Regaining functional use of arm and hand
- Restoring mobility
- Improving balance
- Improving cognitive (thinking) skills including memory and attention
- Improving language and word-finding skills
- Swallowing difficulties
- Patient and family education
Smoking Cessation
If you smoke, quit, or don’t stop. Wellstar offers smoking cessation programs that educate people about smoking risks, encourage behavior modification to help minimize smoking urges and offer numerous coping strategies.