Subdural hematoma
Subdural hemorrhage; Traumatic brain injury - subdural hematoma; TBI - subdural hematoma; Head injury - subdural hematomaA subdural hematoma is a collection of blood between the covering of the brain (dura) and the surface of the brain.
Causes
A subdural hematoma is most often the result of a severe head injury. This type of subdural hematoma is among the deadliest of all head injuries. The bleeding fills the brain area very rapidly, compressing brain tissue. This often results in brain injury and may lead to death.
With any subdural hematoma, tiny veins between the surface of the brain and its outer covering (the dura) stretch and tear, allowing blood to collect. In older adults, the veins are often already stretched because of brain shrinkage (atrophy) and are more easily injured.
A chronic subdural hematoma is more often seen in older adults. This type of subdural hematoma may be due to blood that persists after an acute injury or the result of slowly leaking blood. These can occur after a minor head injury and may go unnoticed for many days.
Chronic subdural hematoma
A chronic subdural hematoma is an "old" collection of blood and blood breakdown products between the surface of the brain and its outermost covering ...
Read Article Now Book Mark ArticleSome subdural hematomas occur without cause (spontaneously).
The following increase the risk for a subdural hematoma:
- Medicines that thin the blood (such as warfarin or aspirin)
- Long-term alcohol use
- Medical conditions that make your blood clot poorly
- Repeated head injury, such as from falls
- Very young or very old age
In infants and young children, a subdural hematoma may occur after child abuse and are commonly seen in a condition called shaken baby syndrome.
Shaken baby syndrome
Shaken baby syndrome is a severe form of child abuse caused by violently shaking an infant or child.
Read Article Now Book Mark ArticleSymptoms
Depending on the size of the hematoma and where it presses on the brain, any of the following symptoms may occur:
- Drowsiness, confusion, or coma
- Decreased memory
- Problem speaking or swallowing
Swallowing
Difficulty with swallowing is the feeling that food or liquid is stuck in the throat or at any point before the food enters the stomach. This proble...
Read Article Now Book Mark Article - Problems with balance or walking
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Headache
Headache
A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better...
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Seizures or loss of consciousness
Seizures
A seizure is the physical changes in behavior that occurs during an episode of specific types of abnormal electrical activity in the brain. The term ...
Read Article Now Book Mark Article - Nausea and vomiting
- Weakness or numbness of arms, legs, face
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Vision problems
Vision problems
There are many types of eye problems and vision disturbances, such as: Halos Blurred vision (the loss of sharpness of vision and the inability to see...
Read Article Now Book Mark Article - Behavioral changes or psychosis
Psychosis
Psychosis occurs when a person loses contact with reality. The person may: Have false beliefs about what is taking place, or who one is (delusions)S...
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In infants, symptoms may include:
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Bulging fontanelles (the soft spots of the baby's skull)
Bulging fontanelles
A bulging fontanelle is an outward curving of an infant's soft spot (fontanelle).
Read Article Now Book Mark Article - Separated sutures (the areas where growing skull bones join)
- Feeding problems
- Seizures
- High-pitched cry, irritability
- Increased head size (circumference)
- Increased sleepiness or lethargy
Lethargy
Fatigue is a feeling of weariness, tiredness, or lack of energy.
Read Article Now Book Mark Article - Persistent vomiting
Exams and Tests
Get medical help right away after a head injury. Do not delay. Older adults should receive medical care if they show signs of memory problems or mental decline, even if they don't seem to have an injury.
Your health care provider will ask about your medical history. Your physical exam will include a careful check of your brain and nervous system for problems with:
- Balance
- Coordination
- Mental functions
- Sensation
- Strength
- Walking
If there is any suspicion of a hematoma, an imaging test, such as a CT or MRI scan, will be done.
CT
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.
Read Article Now Book Mark ArticleMRI scan
A head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...
Read Article Now Book Mark ArticleTreatment
A subdural hematoma is an emergency condition.
Emergency surgery may be needed to reduce pressure within the brain. This may involve drilling a small hole in the skull to drain any blood and relieve pressure on the brain. Large hematomas or solid blood clots may need to be removed through a procedure called a craniotomy, which creates a larger opening in the skull.
Craniotomy
Brain surgery is an operation to treat problems in the brain and surrounding structures.
Read Article Now Book Mark ArticleMedicines that may be used depend on the type of subdural hematoma, how severe the symptoms are, and how much brain damage has occurred. Medicines may include:
- Diuretics (often given intravenously) and corticosteroids to reduce swelling
- Anti-seizure medicines to control or prevent seizures
Outlook (Prognosis)
The outlook depends on the type and location of head injury, the size of the blood collection, and how soon treatment is started.
Acute subdural hematomas have high rates of death and brain injury. Chronic subdural hematomas have better outcomes in most cases. Symptoms often go away after the blood collection is drained. Physical therapy is sometimes needed to help the person get back to their usual level of functioning.
Seizures often occur at the time the hematoma forms, or up to months or years after treatment. But medicines can help control the seizures.
Possible Complications
Complications that may result include:
-
Brain herniation (pressure on the brain severe enough to cause coma and death)
Brain herniation
Brain herniation is the shifting of the brain tissue from one space in the skull to another through various folds and openings.
Read Article Now Book Mark ArticleComa
Decreased alertness is a state of reduced awareness and is often a serious condition. A coma is the most severe state of decreased alertness from whi...
Read Article Now Book Mark Article - Persistent symptoms such as memory loss, dizziness, headache, anxiety, and difficulty concentrating
Anxiety
Stress is a feeling of emotional or physical tension. It can come from any event or thought that makes you feel frustrated, angry, or nervous. Stres...
Read Article Now Book Mark Article - Seizures
- Short-term or permanent weakness, numbness, difficulty speaking
When to Contact a Medical Professional
A subdural hematoma is a medical emergency. Call 911 or the local emergency number, or go to an emergency room after a head injury. Do not delay.
Spinal injuries often occur with head injuries, so try to keep the person's neck still if you must move them before help arrives.
Prevention
Always use safety equipment at work and play to reduce your risk for a head injury. For example, use hard hats, bicycle or motorcycle helmets, and seat belts. Older individuals should be particularly careful to avoid falls.
References
Kolias AG, Taisic T, Chari A, Hutchinson PJ, Santarius T. Medical and surgical management of chronic subdural hematomas. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 47.
Papa L, Goldberg SA. Head trauma. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 33.
Stippler M, Mahavadi A. Craniocerebral trauma. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 62.
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Subdural hematoma - illustration
Subdural hematoma develops when tiny veins that are located between the membranes covering the brain (the meninges) leak blood after an injury to the head. This is a serious condition since the increase in intracranial pressure can cause damage to brain tissue and loss of brain function.
Subdural hematoma
illustration
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Increased intracranial pressure - illustration
Increased intracranial pressure is almost always indicative of severe medical problems. The pressure itself can be responsible for further damage to the central nervous system by decreasing blood flow to the brain or by causing the brain to herniate (push through) the opening in the back of the skull where the spinal cord is attached. Causes of increased intracranial pressure may include bleeding into the subdural space (subdural hematoma).
Increased intracranial pressure
illustration
-
Subdural hematoma - illustration
Subdural hematoma develops when tiny veins that are located between the membranes covering the brain (the meninges) leak blood after an injury to the head. This is a serious condition since the increase in intracranial pressure can cause damage to brain tissue and loss of brain function.
Subdural hematoma
illustration
-
Increased intracranial pressure - illustration
Increased intracranial pressure is almost always indicative of severe medical problems. The pressure itself can be responsible for further damage to the central nervous system by decreasing blood flow to the brain or by causing the brain to herniate (push through) the opening in the back of the skull where the spinal cord is attached. Causes of increased intracranial pressure may include bleeding into the subdural space (subdural hematoma).
Increased intracranial pressure
illustration
Review Date: 6/13/2024
Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.