Subdural Hematoma

An accumulation of blood outside the brain is known as a subdural hematoma. They are typically brought on by severe head injuries. A subdural hematoma can cause life-threatening bleeding and increased pressure on the brain. Some abruptly come to a stop, while others require surgical drainage.

Blood gathers between the layers of tissue that encircle the brain in a subdural hematoma. The dura is the name for the topmost layer. Bleeding occurs between the dura and the arachnoid, the next layer, in a subdural hematoma.

Instead of inside the brain, the bleeding is under the skull and external to the brain. However, when blood collects, the pressure on the brain increases. Symptoms result from the strain on the brain. A subdural hematoma can cause unconsciousness and even death if the pressure inside the skull reaches an extremely high degree.

Subdural Hematoma Symptoms

Subdural hematoma symptoms are mostly influenced by the rate of bleeding:

1. When a subdural hematoma results from sudden, substantial bleeding after a head injury, the victim may immediately pass unconscious or perhaps enter a coma.

2. After suffering a brain injury, a person could appear normal for a few days before gradually losing consciousness a few days later. This is due to a subdural hematoma that is slowly growing as a result of slowed bleeding.

3. For more than two weeks after the bleeding begins, there may not be any symptoms in very slow-growing subdural hematomas.

Symptoms of subdural hematoma include:

1. Headache

2. Confusion

3. Change in behavior

4. Dizziness

5. Nausea and vomiting

6. Lethargy or excessive drowsiness

7. Weakness

8. Apathy

9. Seizures

The symptoms vary depending on a few factors. Your age and other health issues, in addition to the subdural hematoma's size, can influence how your body reacts. Older individuals are more likely to have slow-growing subdural hematomas. They may cause apathy and minor psychological changes.

Subdural Hematoma Causes

A significant head injury is most frequently what causes a subdural hematoma. Among all head traumas, this particular subdural hematoma is one of the deadliest. Brain tissue is compressed as the bleeding rapidly fills the brain region. This frequently causes brain damage and may be fatal.

A slight head injury might also result in subdural hematomas. The bleeding is less severe and happens more gradually. Elderly people are more likely to get this kind of subdural hematoma. These are known as persistent subdural hematomas and may go undiagnosed for several days to weeks.

Tiny veins between the surface of the brain and its outer covering (the dura) stretch and rip in any subdural hematoma, allowing blood to accumulate. Due to brain atrophy, veins in older persons are frequently already strained and more vulnerable to injury.

Some subdural hematomas develop randomly (spontaneously).

These factors raise the chance of developing a subdural hematoma:

1. Blood-thinning medications (such as warfarin or aspirin)

2. Regular alcohol intake

3. Health issues that affect how well your blood clots

4. Consistent head injuries from falls, for example

5. Extreme youth or old age

A subdural hematoma can develop in newborns and young children after child abuse and is frequently observed in a condition known as shaken baby syndrome.

Subdural Hematoma Diagnosis

Following a head injury, patients frequently have their heads imaged, typically via a computed tomography (CT) scan or magnetic resonance imaging (MRI) (MRI scan). These exams produce images of the skull's interior and typically identify any subdural hematomas. Although CT is quicker and more accessible, MRI detects subdural hematomas slightly more effectively.

An angiography may very seldom be utilised to identify a subdural hematoma. A catheter is placed during an angiography (angiogram) through a groin artery and threaded into the arteries of the neck and brain. After injecting a special dye, an X-ray screen displays the blood flowing through the arteries and veins.

Subdural Hematoma Treatment

The severity of subdural hematomas determines how to treat them. From watchful waiting to brain surgery, treatment options are available.

The only recommended course of action for minor subdural hematomas with moderate symptoms may be observation. It is common practice to do repeated head imaging exams to check on the subdural hematoma's progress.

Surgery is necessary to relieve the pressure on the brain in cases of more severe or deadly subdural hematomas. Different surgical procedures can be used to treat subdural hematomas:

1. Burr hole trephination- This procedure involves drilling a hole through the skull above the site of the subdural hematoma and sucking the blood out of the hole.

2. Craniotomy- More of the skull is cut away to provide better access to the subdural hematoma and relieve pressure. Immediately following the treatment, the excised skull is replaced.

3. Craniectomy - To allow the wounded brain to enlarge and expand without suffering long-term harm, a portion of the skull is removed for an extended period of time. Subdural hematoma is not frequently treated with a craniectomy.

Serious illness necessitates the use of machines to maintain breathing and other forms of life support in people with severe subdural hematomas.

Improvements in blood coagulation should be made if a person has a bleeding issue or is taking blood thinners. This can entail administering medications or blood products and, if practical, stopping any blood thinners. There may also be a need for additional medications to help manage seizures or to help lower brain pressure or swelling.

Subdural Hematoma Complications

Serious consequences from some subdural hematomas might result in coma or even death. This may occur if the hematoma is left untreated or even occasionally following therapy. Potential issues include:

1. Brain herniation - Pressure in the brain can cause tissue to shift from its normal position. Death may result from this.

2. Additional bleeding incidents- If you're older, you run a higher risk of experiencing another hemorrhage while you're recovering from the first one, particularly if you've had head trauma.

3. Seizures – Even after treating your hematoma, seizures may still occur.

A senior neurosurgeon of international repute with excellent management skills and one of the Best Neurosurgeons in Kolkata, Dr. Kaushik Sil has over 16 years of experience in treating complex Brain and Spine problems like brain tumours, spinal disc prolapse, brain stroke, subdural hematoma, spinal deformity with a special interest in childhood neurosurgical problems like hydrocephalus and spinal birth defects. His simple guidance and high success in treatment rates is immaculate.