Everything you must know about Subdural Hematoma.

What is a subdural hematoma?

Usually caused by severe head injuries, a subdural hematoma (SDH) refers to the collection of blood inside the head but outside the actual brain tissue. Bleeding occurs between the brain’s outermost layer, known as dura, and the next layer, the arachnoid.

Resulting from tears in the bridging veins, a subdural hematoma causes increased pressure on the skull, leading to damage to the brain tissue. If the pressure rises to a very high level, it can be life-threatening and lead to death.

Types of subdural hematoma

Subdural hematoma is classified into different types based on the amount of bleeding, the speed of its development, and the damage it causes. Following are the different types of SDH:

• Acute subdural hematoma: The most dangerous type of subdural hematoma, its symptoms are severe and appear within minutes to hours of a head injury. Here, the blood pools quickly, leading to tremendous pressure on the brain, causing paralysis, unconsciousness, or even death. This type requires immediate treatment.
• Subacute SDH: This type of SDH can occur due to a concussion. The symptoms are not that severe and present days or even weeks after the head injury.
• Chronic SDH: Generally experienced by older people, this takes weeks to develop symptoms. It can even be caused due to minor head injuries. The symptoms appear slowly, making them difficult to notice.

Who is more likely to get a subdural hematoma?

The following are at risk of suffering from a subdural hematoma:

1. Older people: The brain shrinks due to old age, leading the gap between the skull and the brain to widen. Due to this, the tiny veins in the membranes between the skull and the brain begin to stretch, causing a tear even during a minor head injury.
2. Infants: Due to underdeveloped neck muscles and being unable to protect themselves from a head injury, SDH is seen in infants and young children after child abuse. It is known as ‘shaken baby syndrome’.
3. Contact sports-playing athletes: High-impact sports such as football might cause a blow to the player’s head, increasing the risk of a subdural hematoma.
4. Haemophiliacs: People suffering from haemophilia have clotting deficiencies. This can cause an increased risk of uncontrollable bleeding after a head injury.
5. Alcoholics: Due to alcoholic liver damage, alcoholics cannot produce enough proteins that aid in clotting, increasing the risk of uncontrolled bleeding.
6. Blood-thinning medications: Blood-thinners such as aspirin, warfarin, etc. slow down the clotting process or prevent the blood from clotting. This, again, increases the risk of uncontrolled bleeding even after a minor injury.

Symptoms of a subdural hematoma

Subdural hematoma symptoms include the following:

• Severe headache
• Nausea
• Drowsiness
• Dizziness
• Imbalanced walking
• Slurred (not clear) speech
• Vision changes
• Weakness and loss of muscle strength on one side of the body
• Memory loss
• Confusion and disorientation
• Changes in personality

Severe cases of subdural hematoma show the following symptoms:

• Breathing issues
• Convulsions
• Hemiplegia or Paraplegia
• Unconsciousness or coma

Diagnosis of subdural hematoma

Your healthcare provider will perform a thorough physical examination by checking your blood pressure and heart rate, examining your eyes, and looking for any other signs of bleeding.

They will also ask you about any previous diseases, the medications you are on, the history of any injury, etc. Sometimes you may need to get an angiography to check for any bleeding in the vessels of the brain.

Besides that, they may order a CT scan and MRI of the skull and brain to locate the bleeding. They can then prescribe some blood tests to understand if there has been any blood loss indicating the presence of a subdural hematoma.

Treatment for subdural hematoma

The choice of treatment for a subdural bleed depends on the size and location of the bleeding and the patient’s symptoms.

Typically, those suffering from a subdural haemorrhage need hospitalisation, life support care, and surgical management. However, some hematomas are very small, and the body can absorb those with the help of non-surgical measures.

• Surgical management: Draining out the hematoma through surgery reduces the pressure on the brain and relieves symptoms. Various surgical techniques are employed to manage a brain hematoma. Craniotomy and craniectomy surgeries are where a part of the skull is removed to drain out the hematoma. Sometimes, a burr hole is drilled into the skull to suction out the hematoma.
• Non-surgical management: Very small hematomas mostly do not require surgery and are managed by close monitoring, bed rest, and medicines. Within a few months, the hematoma is absorbed by the body. Until then, regular CT scans and MRIs are performed to observe the subdural bleed and improvement in the symptoms.
• Medicines: Doctors prescribe anti-seizure medication to prevent any seizures that may occur as a result of pressure on the brain caused by the hematoma. Anti-inflammatory medicines are prescribed to reduce brain inflammation.

Complications of subdural hematomas

A brain hematoma can cause complications depending on its size and location, the individual’s age and overall health, the severity of the injury, and some medications that may delay the healing procedure.

Seizures, permanent loss of muscle strength, brain herniation, and chronic numbness are some complications arising from subdural hematomas.

An extensive bleed or subdural hematoma bilateral can cause too much pressure on the brain and may lead to coma or even death.

Prevention of subdural hematoma

The prevention of a brain haemorrhage is targeted at eliminating the causative factors. Some types of hematomas may not be prevented; however, you can take measures to at least reduce the risk.

1. Preventing head injury: Wearing a helmet or headgear while driving or involved in a high-risk job will save you from any head injury. Getting your eyesight checked regularly to prevent falls and avoiding any obstacles at home to prevent tripping are some other measures to avoid head injuries.
2. Reducing alcohol intake: Excessive alcohol can increase the chances of bleeding during injury. Limit alcoholic beverages to two per day.
3. Precautions while on blood thinners: If you are taking blood thinners, you might be at increased risk of having a brain hematoma. Therefore, be extra careful while you are on blood thinners.

Conclusion

Since subdural hematomas are life-threatening, they need to be prevented. If you develop them somehow, you need immediate treatment.

The CK Birla Hospital(R) is a leading healthcare institution that offers subdural hematoma treatment at all our state-of-art facilities. We have a qualified neurosurgery department with the latest facilities and technologies to manage these cases, along with the expertise of doctors who have conducted numerous surgeries.

Visit the CK Birla Hospital(R) or book an appointment with Dr. Rajeev Gupta

FAQs

How long can you have a subdural hematoma?

Some patients with a subdural hematoma may recover in a few weeks or months, while others don’t recover even after years.

How do doctors treat a subdural hematoma?

A subdural bleed primarily requires a craniotomy, a surgical treatment.

What are the chances of surviving a subdural hematoma?

About 50% of patients survive after a subdural haemorrhage, though permanent brain damage may occur after it has been experienced.

Can you fully recover from a subdural hematoma?

Depending on the location, size, and severity of the subdural hematoma, it may subside completely in a few months, or the residual effect may last for a long time.

Can subdural hematoma be treated without surgery?

Sometimes, small subdural hematomas can be managed non-surgically with regular monitoring.