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Subdural Hematoma

A subdural hematoma is a collection of blood outside the brain. Blood collects between the layers of the tissue that surround the brain. The bleeding of a subdural hematoma is not in the brain itself. However, as blood accumulates the pressure on the brain increases. This pressure causes the symptoms of this condition and if the pressure on the brain rises to a high level it can cause unconsciousness, even death.

Causes

Subdural hematomas are usually caused by a serious head injury such as a fall, a motor vehicle accident or possibly an assault or sporting accident. This is considered an "acute" subdural hematoma. People who are on blood thinners are more likely to get a subdural hematoma from even a slight injury. In "chronic" subdural hematomas, the small veins on the outer surface of the brain tear and cause bleeding in the subdural space. Symptoms of this type may not appear for days or weeks.

Symptoms

Symptoms of a subdural hematoma may be sudden or gradual depending on the circumstance and cause. Sudden subdural hematomas from injury may cause a person to lose consciousness or go into a coma immediately. In the event of an injury where there are no immediate symptoms a person may appear normal for several days after slowly becoming confused and possibly unconscious several days later. This may cause the subdural hematoma to slowly grow causing pressure on the brain. Even in a slight injury with a slow growing hematoma, there may not be any symptoms for weeks after the injury. Symptoms may include:

  • Headache
  • Dizziness
  • Confusion
  • Nausea and/or vomiting
  • Drowsiness or lethargy
  • Weakness
  • Seizures

Diagnosis

Individuals who present to and emergency room or seek medical attention after a head injury will undergo scans such as CT scans or MRI scans to detect the presence of a subdural hematoma.

Treatment of a subdural hematoma will depend on the severity. Treatment can range from monitoring to necessary brain surgery. In small subdural hematomas no treatment may be necessary other than careful observation. It may be necessary to follow up with CT scans over a period of time to ensure that the subdural hematoma is improving. More severe subdural hematomas will require surgery to reduce the pressure on the brain. There are a few different surgical techniques that your surgeon may use to treat a subdural hematoma.

  • Burr hole drainage – a hold is drilled in the area over the subdural hematoma and the blood is suctioned out through the hole.
  • Craniotomy – a larger section of the skull is removed to gain access to the subdural hematoma and relieve pressure. After the subdural hematoma is drained, the section of the skull is replaced.
  • Craniectomy – although not usually used to treat a subdural hematoma, this method is when a portion of the skull is removed to a period of time to allow the brain to expand without further damage to the brain.

The experts at SCCNS are very experienced in the treatment of subdural hematomas that have occurred due to injury or other illnesses. They can guide and educate a patient and their family in order to understand all necessary treatment.

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