A subdural hematoma (SDH) is a collection of blood between the dura mater and the arachnoid mater, two membranes covering the brain. This bleeding is caused by tears in the bridging veins that cross the subdural space, often resulting from a head injury. The accumulating blood can increase pressure inside the skull, leading to the compression and damage of brain tissue. Life expectancy after an SDH varies widely depending on the specifics of the injury and the individual patient.
Immediate Survival and Treatment Impact
Survival often depends on whether the hematoma is acute or chronic. Acute subdural hematomas are the most dangerous type, developing rapidly with severe symptoms appearing within hours of a head injury. This rapid bleeding quickly increases pressure on the brain, making immediate diagnosis and treatment necessary to prevent paralysis or death.
Chronic subdural hematomas develop more slowly, with symptoms sometimes taking weeks or months to appear. These are more common in older adults, where even a minor head injury can cause a slow bleed. Because the bleeding is slower, the body has more time to accommodate, and the prognosis is better than for acute cases if managed properly.
The goal of immediate treatment for a significant subdural hematoma is to relieve pressure on the brain. Large, acute hematomas almost always involve emergency surgery. Neurosurgeons may perform a craniotomy, which involves removing a section of the skull to access the clot, or use burr holes to drain the collected blood. For smaller or chronic hematomas without severe symptoms, medical teams might opt for observation to see if the body reabsorbs the blood on its own.
Key Factors Determining Prognosis
The long-term outlook after a subdural hematoma is shaped by several factors.
- Age is a primary element, as older patients tend to have worse outcomes. Brain shrinkage with age can stretch and weaken the bridging veins, making them more susceptible to tearing. Mortality rates for acute SDH are higher in older age groups, with one study noting a mortality of 88% for patients over 80 compared to 20% for those under 40.
- A patient’s neurological state upon admission is a strong predictor of function. Doctors use the Glasgow Coma Scale (GCS) to score a person’s level of consciousness. A lower GCS score is associated with higher mortality and poorer functional recovery, as patients with a severe score (3-8) have a lower chance of recovery than those with a moderate to mild score (9-15).
- The hematoma’s characteristics play a direct role in the prognosis. The size of the blood collection and the degree of midline shift (how far the brain is pushed sideways) are important markers. A larger hematoma or a midline shift over 10 millimeters is linked to worse outcomes. Acute SDHs from high-impact trauma are the most lethal, often because they are accompanied by other severe brain injuries.
- A person’s overall health before the injury can complicate recovery. The use of anticoagulant medications (blood thinners) is associated with higher mortality. Pre-existing conditions like cardiovascular disease, diabetes, or long-term alcohol use can negatively affect the body’s ability to heal, make surgery riskier, and slow rehabilitation.
Long-Term Complications and Quality of Life
Surviving an SDH can lead to lasting consequences. A common complication is the development of seizures, or post-traumatic epilepsy, which may require long-term medication. The risk of the hematoma returning also exists, particularly in older individuals, and may necessitate further surgery.
Cognitive and psychological changes are frequent after an SDH. Survivors may experience persistent issues with memory, attention, and concentration. Personality and mood can also be altered, leading to anxiety, confusion, or other behavioral changes that impact daily life.
Physical disabilities are another potential outcome. Depending on the injury’s location and severity, patients may have weakness in their limbs, problems with balance, or difficulty with speech. These impairments can range from minor coordination issues to paralysis, influencing a person’s independence and quality of life.
Managing these long-term issues is a part of post-hematoma care. The goal shifts from survival to maximizing functional ability. Regular follow-up appointments and brain scans are necessary to monitor for recurrence or other problems. The cumulative effect of these challenges can influence long-term health and life expectancy.
The Role of Rehabilitation and Ongoing Care
Once a patient’s condition is stable, a rehabilitation program supports recovery. This process is tailored to the individual’s deficits and involves a team of healthcare professionals. The recovery timeline varies, with the objective being to help the brain relearn lost functions and teach compensatory strategies.
Physical therapy focuses on restoring movement, strength, and coordination. Therapists guide patients through exercises to improve balance, walking, and mobility in weakened limbs. For those with severe impairments, this therapy also helps prevent secondary complications like muscle shortening or joint stiffness.
Occupational therapy helps individuals relearn skills for daily living, from personal grooming to more complex activities for work or school. Speech and language therapists address problems with communication or swallowing. Consistent medical follow-up is also necessary to manage long-term complications like seizures or mood disorders.