A subdural hemorrhage or subdural hematoma is an intracranial hemorrhage characterized by bleeding in the skull. Essentially, the bleeding occurs beneath the dura, a protective layer covering the brain. It occurs as a result of a burst blood vessel, typically a vein. Over time, the bleeding causes pressure on the brain, impeding its functionality.
The most common cause of subdural hemorrhage is a head injury. In fact, up to one-fifth of patients with traumatic brain injury experience subdural hemorrhage. These injuries can occur because of a road accident, fall, or other impact. Athletes who play contact sports can also suffer head injuries. Outside of head injuries, a subdural hemorrhage can occur because of a head infection or tumor. Adults who take blood thinning medication are at a high risk of developing this condition.
There are three types of subdural hemorrhage: acute, subacute, and chronic. Acute subdural hemorrhage occurs rapidly and is often the result of a traumatic head injury like a blow to the head. Symptoms appear minutes or hours after injury. These include vision changes, confusion, drowsiness, slurred speech, muscle weakness, and difficulty balancing. Others are numbness, headaches, and vomiting. The symptoms show that blood is building up rapidly in the skull, requiring prompt medical treatment.
Subacute subdural hemorrhage is characterized by slower bleeding. Thus, the symptoms take longer to emerge, sometimes days or weeks after the injury. While it is not as dangerous as acute subdural hemorrhage, it is also a serious condition that requires treatment to prevent buildup of pressure on the brain.
With chronic subdural hemorrhage, the bleeding occurs over an even longer time frame. Hence, symptoms can appear months after the injury.
People who suspect they may have suffered a traumatic brain injury should immediately see a doctor, even if they appear to be okay. If they experience any of the symptoms of a subdural hemorrhage, either immediately following or weeks after an injury, they should rush to the emergency room.
To diagnose a subdural hemorrhage, doctors typically rely on tests such as a CT scan or MRI (magnetic resonance imaging). Both tests give doctors an in-depth look at the skull and brain, enabling them to identify signs of blood accumulation on the brain’s surface. The doctor may also recommend a complete blood count (CBC) test to assess the level of the blood’s red blood cells. Low levels of red blood cells indicate bleeding.
Once a doctor makes a subdural hemorrhage diagnosis, they will give an appropriate treatment recommendation. For small hematomas with slow or minimal bleeding, the doctor will likely recommend observation. Here, the patient is advised to get some rest and may even be prescribed some medication. However, they must commit to follow-up visits with their doctor.
For severe hematomas, as is typically the case with acute subdural hemorrhages, the doctor will recommend surgery to drain the blood in the skull. A common surgical approach is to drill holes in the skull, insert rubber tubes into them leading to the intracranial hemorrhage site, and letting the blood drain out. Doctors may have to open the skull to remove blood clots where they have formed. Otherwise, they will leave the drain in place for some days to allow continuous draining.
Left untreated, subdural hemorrhage can lead to brain herniation, where the pressure squeezes the brain out of its normal position, impeding normal functioning. Subdural hemorrhage can also lead to seizures, coma, and death.
Prevention is better than cure. To avoid suffering head injuries that may cause subdural hemorrhage, people should protect their heads when engaging in contact sports like football, wear a helmet when riding a bicycle or motorcycle, and use protective headgear when working in areas like construction sites. Seniors should remove tripping hazards from their homes and install grab bars in bathrooms and handrails along stairs to reduce the chances of falling. If a person suffers a head injury, they should seek medical attention promptly.
