A traumatic subdural hematoma is a serious type of bleeding inside the head that occurs after a head injury. It involves a collection of blood that forms between the brain’s surface and its protective outer covering. This condition can rapidly increase pressure within the skull, potentially damaging brain tissue and impairing brain function. Prompt medical attention is highly advised if a traumatic subdural hematoma is suspected.
What is Traumatic Subdural Hematoma
The brain is enveloped by three layers of membranes called the meninges, which provide protection. The dura mater is the tough, outermost layer, situated closest to the skull. Beneath the dura mater lies the arachnoid mater, a delicate, web-like middle layer. The innermost layer, the pia mater, adheres directly to the brain’s surface.
A subdural hematoma forms when blood collects in the space between the dura mater and the arachnoid mater. This bleeding results from the tearing of tiny veins, known as bridging veins, which connect the brain’s surface to the dural sinuses. These veins are vulnerable to sudden acceleration or deceleration forces that cause the brain to shift within the skull.
Such forces can stretch and rupture these veins, allowing blood to leak into the subdural space. Common causes include severe head injuries from falls, motor vehicle accidents, assaults, and sports-related impacts. The bleeding can occur rapidly, leading to a rapid accumulation of blood that compresses brain tissue.
Elderly individuals are at higher risk because their brains can shrink with age, widening the space between the brain and the skull and stretching the bridging veins, making them more prone to tearing. Young children, due to weaker neck muscles, and individuals taking blood thinners also face increased risk.
Signs and When to Seek Medical Help
The presentation of symptoms for a traumatic subdural hematoma can vary, depending on the speed and volume of bleeding. Acute subdural hematomas manifest within hours to days following the head injury. This rapid onset of symptoms indicates a severe bleed requiring immediate intervention.
Common signs of an acute subdural hematoma include a persistent or worsening headache, confusion, and changes in behavior or personality. Slurred speech, weakness or numbness on one side of the body, and loss of consciousness may occur. Nausea, vomiting, and seizures are signs indicating increased pressure on the brain.
Chronic subdural hematomas, by contrast, develop more slowly, with symptoms appearing weeks to months after the initial injury. The initial head trauma might have seemed minor, and the delayed onset of symptoms can make diagnosis challenging. Symptoms are similar to acute cases but may progress more gradually.
Regardless of when symptoms appear, seek immediate medical attention for any suspected head injury. Even if the initial injury seems mild or if symptoms are delayed, a subdural hematoma is life-threatening, requiring prompt evaluation by a healthcare provider. Early recognition and treatment can improve outcomes.
How Traumatic Subdural Hematoma is Diagnosed and Treated
Diagnosing a traumatic subdural hematoma relies on imaging techniques to visualize the brain and surrounding structures. A computed tomography (CT) scan of the brain is the most common initial diagnostic tool. This scan uses X-rays to create detailed cross-sectional images, to quickly identify the location and size of blood collections.
Magnetic resonance imaging (MRI) may also be used, providing more detailed images of brain tissue and blood. These imaging studies are important for determining the extent of the hematoma and assessing any associated brain injury. The appearance of the blood on these scans also helps determine how recently the bleeding occurred.
Treatment approaches for traumatic subdural hematomas vary based on the hematoma’s size, stability, and the patient’s symptoms. Small, stable hematomas not causing pressure on the brain may be managed conservatively. This involves close monitoring of neurological status, pain management, and intracranial pressure control through medications.
For larger or symptomatic hematomas causing pressure on the brain, surgical intervention is necessary to remove the blood clot and relieve pressure. One common surgical procedure is a craniotomy, where a section of the skull is temporarily removed to allow direct access to the hematoma. The blood clot is then removed.
Another surgical option is burr hole trephination, which involves drilling one or more small holes in the skull. Through these holes, a catheter can be inserted to drain the blood. The goals of these treatments are to reduce the pressure on the brain and to prevent further damage to brain tissue.
Life After a Traumatic Subdural Hematoma
The recovery process following a traumatic subdural hematoma is individualized and varies based on several factors. The severity of the initial injury, promptness of treatment, and overall health and age all play a role in determining the long-term outcome. Recovery can be a lengthy process.
Individuals may experience a range of long-term effects. Cognitive impairments are common, including memory issues, difficulty concentrating, and executive function difficulties. Physical deficits such as weakness on one side of the body, balance problems, and coordination difficulties may persist.
Emotional and behavioral changes, including mood swings, irritability, or depression, can occur. Seizures are also a risk, which may appear immediately after the injury or months to years later. Medications help manage these seizures.
Rehabilitation therapies are an important part of the recovery journey. Physical therapy restores strength, balance, and mobility. Occupational therapy helps regain independence in daily activities, while speech therapy addresses communication and swallowing difficulties. Cognitive therapy helps with memory, attention, and other thinking skills.
Ongoing follow-up care with medical professionals is important to monitor for complications or recurrence of the hematoma. This monitoring helps ensure new issues are addressed promptly, supporting long-term health.