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Subdural Hematoma

(Extra-axial Haematoma; Subdural Haemorrhage; SDH)

Pronounced: sub-dur-al hee-ma-toe-ma

Definition

A hematoma is a collection of blood. A subdural hematoma develops in the space between the covering of brain (the dura) and the inside of the skull. This pool of blood can put pressure on the brain and cause a range of symptoms.

Causes    TOP

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. It can also occur spontaneously.

Head Injury

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Risk Factors    TOP

Factors that increase your chance of a subdural hematoma include:

Symptoms    TOP

The blood may pool quickly or take some time to build up. This will affect how fast 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
  • Vision problems

Seek medical care right away if you have any of these symptoms after a head injury.

Diagnosis    TOP

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.

Imaging tests evaluate the brain and surrounding structures. This can be done with:

Your brain function may be assessed. This can be done with:

  • Neurological examination
  • Electroencephalogram EEG—to measure your brain's electrical activity
  • Neuropsychological testing

Your bodily fluids may be tested. This can be done with blood tests.

Treatment    TOP

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.

Medications

Medication may be given to relieve symptoms. Some medications may include:

  • Antiseizure medication—if seizures have occurred
  • Steroids—to decrease brain swelling.

Surgery    TOP

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    TOP

To help reduce your chance of a head injury:

  • 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 medication.
  • 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 Otolaryngology—Head and Neck Surgery
http://www.entnet.org
Brain Injury Association of America
http://www.biausa.org

CANADIAN RESOURCES:

Brain Injury Canada
http://braininjurycanada.ca
Ontario Brain Injury Association
http://obia.ca

References:

Servadei F, Compagnone C, Sahuguillo J. The role of surgery in traumatic brain injury. Curr Opin Crit Care. 2007;13(2):163-168.
Subdural hematoma. EBSCO Dynamed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114154/Subdural-hematoma. Updated March 1, 2016. Accessed September 29, 2016.
Subdural haematoma. Patient UK website. Available at:
...(Click grey area to select URL)
Updated September 28, 2011. Accessed June 2, 2014.
Last reviewed May 2016 by Rimas Lukas, MD
Last Updated: 6/2/2014

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This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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