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Subdural Haematoma
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A subdural hematoma is also called a subdural haemorrhage and is a collection of blood that occurs on the surface of the brain, usually as a result of a serious injury to the head. Subdural hematomas can be acute, subacute or chronic. An acute subdural haematoma is very serious and involves a great deal of bleeding in a short period of time. The blood puts pressure on the brain very quickly and this can result in injury to the brain or brain herniation, which is often deadly.
A subdural haematoma can occur after a relatively minor injury, particularly in the elderly. A patient can go without obvious symptoms for several days or weeks and then show symptoms of subdural haematoma. This is when the condition is called a subacute or chronic subdural haematoma.
In a subdural haematoma, the bleeding comes from small veins located between the surface of the brain and the dura mater, the covering to the brain. The veins stretch and ultimately tear, leading to rapid bleeding. In the elderly, these veins are already stretched due to shrinkage of the brain and this is why a subdural haemorrhage is more common in this age group. In rare cases, a subdural hemorrhage can occur without an obvious trauma or other cause.
Things that increase the risk of getting a subdural haematoma include being on blood thinners, having a history of recurrent falls, chronically abusing alcohol, being in sports or other activities that result in repeated head injuries and being very young or perhaps very old.
There can be a variety of symptoms associated with a subdural haemorrhage. These include balance difficulties, headache, confusion, speech slurring or other abnormality of speech, nausea, vomiting, loss of consciousness or coma, lethargy, numbness of the body, new onset of seizures, double vision or other changes in vision and weakness. These symptoms are the most common symptoms in adults and children. Infants have their own set of signs and symptoms of subdural haemorrhage.
In infants, one can see a bulging fontanelle (the soft spots in the skull), difficulties in feeding, seizures (general or focal), a high pitched cry, lethargy or sleepiness, increased size of the head, vomiting, irritability and separation of the sutures of the head.
If you suspect you have a subdural haematoma, seek medical attention immediately. With elderly people, you need to be prepared with more subtle symptoms such as confusion and weakness. Your doctor will look at the cluster of symptoms and may order a CT scan of the head. A CT scan of the head shows blood really easily and you can find the location and size of the bleed. If herniation is imminent, this can be seen on the CT scan in some circumstances. An MRI scan of the head shows blood less obviously, but you can still diagnose a subdural hemorrhage on the basis of the MRI scan.
Subduraal haematomas generally need emergency treatment. The most common treatment is surgery to the skull and brain so that the pressure is relieved from the brain. Emergency doctors can drill a small burr hole in the side of the brain overlying the haematoma so that blood and clot can drain out. In other cases, a big haematoma may need a craniotomy or a bigger hole cut out of the brain. The blood is then removed and the skull cap replaced.
Doctors also use medications to control subdural haematomas. There are steroids used to relieve inflammation, mannatol, which decreases the amount of liquid in the brain and shrinks swelling, and medications for seizures, such as Dilantin or phenytoin.
Complications of a subdural haematoma include brain herniation, which causes coma and death, seizures which last past the acute incident, temporary or permanent weakness or stroke-like symptoms. There can be difficulty concentrating, anxiety, chronic headaches and chronic dizziness. The overall prognosis depends on how big the subdural haematoma is, the location of the subdural haematoma and whether or not there is brain herniation. Acute subdural haemorrhages have the highest rates of injury or death. Subacute and chronic subdural haematomas generally have a better outcome, with complete resolution of their symptoms after the subdural haemorrhage is drained.