• Subdural Hematoma

    (Extra-axial Haematoma; Subdural Haemorrhage; SDH)

    Definition

    A hematoma is a collection of blood. A subdural hematoma develops in the space between the brain and the skull. This pool of blood can put pressure on the brain and cause a range of symptoms.
    This can be serious and life-threatening injury. You will need to seek medical care.

    Causes

    A subdural hematoma is most often caused by a head injury. The injury may be caused by traumas such as falls, car accidents, or physical abuse.
    Head Injury
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    Risk Factors

    Factors that increase your risk of a subdural hematoma include:
    If you have any of these risk factors, tell your doctor.

    Symptoms

    The blood may pool quickly or take some time to build up. This will affect how fast the symptoms develop. The subdural hematoma may be:
    • Acute—symptoms appear soon after the injury
    • Subacute—symptoms appear a few days after the injury
    • Chronic—bleeding is slower and symptoms only appear weeks after the injury
    After a head injury, a subdural hematoma may cause the following symptoms:
    • Loss of consciousness
    • Bruising around the head or eyes
    • Headache
    • Nausea or vomiting
    • Personality changes
    • Limb weakness
    • Fatigue/sleepiness
    • Confusion
    • Speech difficulties
    • Visual impairment
    Seek medical care immediately if you have any of these symptoms after a head injury.

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may also be referred to a specialist for additional testing.
    Your doctor may need pictures of the brain and skull. This may be done with:
    Tests to assess brain function may include:
    • Neurological examination
    • EEG (electroencephalogram)—a noninvasive test used to evaluate brain function
    Blood tests may also be done to look for signs of bleeding.

    Treatment

    Talk with your doctor about the best treatment plan for you. Treatment will depend on the size and severity of the hematoma. It will also be based on your specific symptoms.
    Treatment options include the following:

    Monitor and Observe

    A minor injury with little or no symptoms may not need treatment. Your doctor may simply ask that you watch for any new symptoms. It can take days and weeks for some symptoms to develop.

    Neuropsychological Testing

    These tests assess how well your brain is working. The tests may be repeated while you recover to help your doctor determine:
    • How your recovery is progressing
    • If you are ready to return to high-impact activities

    Medications

    Medication may be given to relieve symptoms. Some medications may include:
    • Antiseizure medication—if seizures have occurred
    • Steroids—to decrease brain swelling.

    Surgery

    Surgery may be needed to relieve pressure on the brain. Surgical procedures that may be considered include:
    • A small hole may be made in the scalp and skull. It will allow the blood clot to drain out of the skull.
    • A section of the skull may be removed. This is called a craniotomy.

    Prevention

    To help reduce your chance of head injury, take these steps:
    • Wear proper helmets when playing sports and riding a bike or motorcycle.
    • Use a seat belt while traveling in car.
    • Reduce the risk of a fall or injury. Safeguard your home and workplace.
    • Have regular blood tests if you are taking blood thinning medicine.
    • Limit your alcohol intake to a moderate level. This means:
      • Two or fewer drinks per day for men
      • One or fewer drinks per day for women

    RESOURCES

    American Academy of Neurology http://www.aan.com/

    American Academy of Otolaryngology, Head and Neck Surgery http://www.entnet.org/

    Brain Injury Association of America http://www.biausa.org/

    CANADIAN RESOURCES

    The Brain Injury Association of Canada http://biac-aclc.ca/

    Ontario Brain Injury Association http://www.obia.on.ca/

    References

    Chronic and subacute subdural hematoma. Barnabas Health website. Available at: http://www.barnabashealth.org/services/neuro/neurosurgery/surgery/brain/hematoma.html . Accessed November 12, 2012.

    Servadei F, Compagnone C, Sahuquillo J. The role of surgery in traumatic brain injury. Curr Opin Crit Care. 2007;13:163-168.

    Subdural hematoma. EBSCO Dynamed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated October 22, 2012. Accessed November 12, 2012.

    Subdural haematoma. Patient UK website. Available at: http://www.patient.co.uk/showdoc/27001513/ . Updated March 2009. Accessed November 12, 2012.

    Acute subdural hematomas. UCLA Neurosurgery website. Available at: http://neurosurgery.ucla.edu/body.cfm?id=102 . Accessed November 12, 2012.

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