Subdural Hematoma: Decoding The Subdural Hemorrhage Causing Condition

A 27-year-old rugby player sustained a head injury during an international match, leading to confusion, changes in vision in his right eye, and weakness in his left leg. Although his neurological exam was normal, he was promptly taken to a trauma center because of his symptoms. He underwent an emergency CT scan which revealed that he had a subdural hematoma with midline shift and it was necessary to immediately remove the hematoma surgically. Fortunately, the player had a successful craniotomy and rehabilitation thereafter. He made a full recovery and did not have any lasting neurological issues. Before this injury, he had 3 other concussions but they didn’t have any complications. This time around quickly reporting his problems and the prompt medical response probably saved the day for him.

Curious to know what exactly is a Subdural hematoma? Read on.

What Is Subdural Hematoma?

A subdural hematoma may be regarded as the Collection of blood between the brain and the outermost covering of the brain, referred to as the dura mater. It is usually associated with head injuries that fracture blood vessels, causing blood to collect in that area. The term denotes the interval since the injury has been subdural hematomas, which may be : 

Acute:-Symptoms appear quickly after injury , often within 24 hours. 

Subacute:-Symptoms appear within a few days or two weeks after the injury. 

Chronic:- Symptoms appear within weeks or months after the injury, often in older adults. Understanding the type of Subdural Hematoma is crucial for determining the appropriate treatment and prognosis. 

Subdural Hematoma Causes

Head Trauma is by far the most frequent cause of subdural hematoma. These events may happen in the following instances: 

1.Falls:- Falls can lead to serious injuries, especially to the head in the elderly Population. 

2:- Road Traffic Accident:- Blood vessels torn under impact from violent collision and can cause traumatic Subdural Hematoma. 

3:- Injuries in Organized Activities:- Contact sports such as football and boxing among others may cause an individual head trauma. 

4:- Deliberate Assaults:- A Subdural Hematoma can also develop due to head punches sustained during a fist fight or an assault. 

Here are some more risk factors: 

Age:– With age, tendons become loose and weak naturally and may result into a hematoma 

Use of alcohol:- it may induce risk factors for injuries and falls

Medication to thin blood: this type of medication can be associated with bleeding risks

 Subdural Hematoma Symptoms

At times, all the signs of a subdural hematoma do not set in immediately. They might show up days, weeks, or even days after the injury has taken place. The non-exhaustive list of common symptoms includes:

1. Ache and discomfort in the head alongside mental haziness or changes 
2. Spinning sensation 
3. Feeling weak and/or numb in some parts of the body 
4. Inability to balance or control the body’s movements properly 
5. In more serious conditions, patients develop convulsions or lapses in consciousness. 

Hence, it is important to assess  for all these symptoms and get medical attention after any trauma to the head. 

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Subdural Hematoma Diagnosis

Usually, for the diagnosis of subdural hematoma, imaging tests are performed. The following options may be offered to the patients: 

CT scans: Effective at quickly recognising the presence of any bleeding and its locations 

MRI examinations: 

MRI scan uses strong magnetic fields and radio waves to produce detailed images of the brain and determine the location and amount of bleeding. It can also show other head and neck injuries. 

The process of diagnosis also includes a physical examination and the gathering of the patient’s medical history: 

Subdural Hematoma Complications

Complications of a subdural hematoma can include: 

• Brain herniation: Severe pressure on the brain that can lead to coma and death 
• Persistent symptoms: These can include headaches, dizziness, memory loss, anxiety, and difficulty concentrating 
• Seizures: These can occur after a subdural hematoma 
• Short-term or permanent weakness: This can affect the limbs 
• Speech problems: These can occur after a subdural hematoma 
• Infection: If bacteria enters the hematoma site, it can lead to an infection. Signs of infection include redness, warmth, swelling, increased pain, or pus. 
• Recurrence: The hematoma could come back after treatment

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Subdural Hematoma Treatment

Depending on the size and severity of the subdural Hematoma treatment options vary. Here are some of them: Monitoring: Doctors may use small hemograms to monitor signs and symptoms 

Subdural Hematoma Medications

to alleviate swelling, pain, and other symptoms. 

Subdural Hemorrhage Surgery

In cases of larger hematomas or where symptoms are significant, there may be a need for a surgical procedure. 

Subdural Hematoma Surgery

Surgery is usually recommended for most cases of subdural hematomas. For very small hematomas, monitoring may be advised initially to see if they heal on their own without surgery. If surgery is needed, a neurosurgeon will typically perform the procedure using one of two main techniques: craniotomy or burr holes. 

Craniotomy

In Craniotomy, a section of the skull is temporarily removed to access the hematoma and remove the hematoma. This kind of surgery is used for acute subdural hematomas that happen after a severe head injury.

During the craniotomy surgery, the surgeon makes a temporary flap in the skull from where they remove the hematoma gently using suction and irrigation, after which the area is washed with fluid. After the surgery is done, the skull portion is placed back and fixed with metal plates or screws. Craniotomy is done under general anesthesia, i.e. the patient will be asleep during the surgery.

Burr Holes Surgery

Burr holes surgery is performed for chronic subdural hematomas that happen a few days or weeks after a minor head injury.

In Burr Hole surgery, one or more holes are drilled into the skull and a flexible rubber tube is inserted. This rubber tube is used to drain the hematoma. Sometimes the tube is left in the site of the injury to drain any remaining blood to avoid repeat hematoma at the site. This kind of surgery is usually done under general anesthesia but sometimes it’s also done under local anesthesia wherein the site of the surgery, I.e. the scalp is numbed so that the patient doesn’t feel any pain but is awake during the surgery.

As with any kind of surgery, there are certain risks associated with subdural hematoma surgery which include further bleeding, infection, blood clots, seizures, and stroke. Sometimes only some part of the hematoma is removed during surgery which results in the symptoms not going away after the surgery.

There is also a chance that the hematoma may recur, necessitating additional drainage.

Recovery from surgery can vary significantly between individuals; some may be able to leave the hospital within a few days, while others might require a longer hospital stay and further treatment for issues like memory problems or weakness.

Overall, recovery times for subdural hematomas differ from person to person, with some achieving full recovery while others may experience lasting effects.

Subdural Hematoma  : When to See a Doctor ?

In case you or a close associate has suffered an injury to the head and developed any of the above symptoms, it is very important to visit the doctor without delay. Prolonging it may worsen the situation and cause more complications. Everything in head injuries is tricky. Thus, be careful. 

Subdural Hematoma : Conclusion

Knowing the signs and when to call for help is important, whether it is a simple fall or a more serious injury to the head. Remain vigilant and do not hesitate to go to the doctor if you or someone else has suffered a hit in the head.

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