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Alternative names Return to top
Subdural hemorrhageDefinition Return to top
A subdural hematoma is a collection of blood on the surface of the brain. It lies beneath the outer covering (the dura) of the brain and the brain's surface.
Causes, incidence, and risk factors Return to top
Subdural hematomas are usually the result of a serious head injury. When this is the cause, they are referred to as "acute" subdural hematomas. Subdural hematomas can also occur spontaneously or after a very minor head injury, especially in the elderly. These go unnoticed for many days to many weeks, and are referred to as "chronic" subdural hematomas. The terms acute, subacute, and chronic reflect how long it takes blood to collect.
Acute traumatic subdural hematomas are among the most lethal of all head injuries (up to 50% lethality). They expand very rapidly, leaving little room for the brain, and are associated with brain injury.
Subdural hematomas occur in about 15% of all head traumas. Tiny veins between the surface of the brain and its outer covering (the dura) stretch and tear, allowing blood to collect. In the elderly, the veins are often already stretched because of brain atrophy (shrinkage).
Risks include:
Symptoms Return to top
In infants:
Signs and tests Return to top
Always seek medical attention following a significant head trauma or mental deterioration in the elderly. The evaluation should include a complete neurologic exam.
Any of the following may prompt the physician to order a brain imaging study:
A CT scan or MRI scan would likely be done to evaluate for the presence of a subdural hematoma.
Treatment Return to top
A subdural hematoma is an emergency condition! Treatment includes lifesaving measures, controlling symptoms, and minimizing or preventing permanent brain damage.
Medications vary according to the type and severity of symptoms and the extent of brain damage. Diuretics may be used to reduce swelling. Anticonvulsant medications such as phenytoin may be used to control or prevent seizures.
Emergency surgery may be required to reduce pressure within the brain. This may involve drilling a small hole in the skull to relieve pressure and allow the hematoma to drain. Large hematomas or solid blood clots may need to be removed through a larger opening in the skull (craniotomy).
Expectations (prognosis) Return to top
The outlook following a subdural hematoma varies widely depending on the type of head injury, the size of the blood collection, and how quickly treatment is obtained.
Acute subdural hematomas present the largest challenge, with high rates of death and injury. Subacute and chronic subdural hematomas have good outcomes in most cases, with symptoms going away after the blood collection is drained.
There is a high frequency of seizures following a subdural hematoma, but these are usually well controlled with medication.
Complications Return to top
Calling your health care provider Return to top
Serious head injuries and complications like subdural hematoma require emergency medical attention. Call 911 or go immediately to an emergency room. Spinal injuries often accompany head injuries, so always consider immobilizing the patient's neck if the patient must be moved before medics arrive.
Prevention Return to top
Use safety equipment and safety precautions at work and play to minimize the risk of a head injury. For example, use hard hats, bicycle or motorcycle helmets, and seat belts. Update Date: 8/14/2004 Updated by: Luc Jasmin, MD, PhD, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA. Review provided by VeriMed Healthcare Network.
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Page last updated: 28 October 2004 |