Acute Subdural Hematoma

Acute Subdural Hematoma

An acute subdural hematoma is a clot that develops between the surface of the brain and the dura mater, the brain’s tough outer covering. It is usually caused due to stretching and tearing of veins on the brain’s surface. These veins rupture when a head injury causes sudden trauma to the brain. Blood accumulates rapidly, causing the pressure within the brain to rise. This can lead to loss of consciousness, paralysis or death. SDHs are seen in 10-20% of all traumatic brain injury cases and occur in up to 30% of all fatal injuries. Traumatic acute SDHs are the most lethal of all head injuries. They often occur with cerebral contusions.

What are the symptoms of Acute SDHs?

Injuries that result in this condition are usually forceful enough to cause a temporary loss of consciousness. Usually, in the minutes to hours after the head trauma, the person might recover consciousness only to lose it again due to subdural bleeding.

Treatment Options

Some SDHs resolve spontaneously but others require treatment depending upon their size, location, severity and the health of the patient

Treatment may include

  • Observation in the case of small subdural hematomas with mild symptoms
  • Medication with diuretics, corticosteroids or anticonvulsants may be used to control or prevent seizures

Severe or dangerous subdural hematomas require any of the following surgery:

  • Burr hole trephination
  • Craniotomy
  • Craniectomy
Worsening headache
Worsening headache
Feeling of being sick
Feeling of being sick
Lethargy 1
Confused state of mind
Confused state of mind or speech
Changes in personality 1
Personality changes
Drowsiness 1
Difficulties with balance
Difficulty with balance or walking
Unconsciousness and death
Unconsciousness & death (if pressure rises very high)
Nausea and vomiting
Nausea and vomiting
Tingling sensation numbness
Disabling seizures
Visual disturbances
Visual disturbances
Weakness or loss of movement

Subdural hematoma is usually caused by a head injury such as

  • A fall
  • Motor vehicle collision
  • Assault
  • Anticoagulant medication (blood thinners, including aspirin)
  • Long-term abuse of alcohol
  • Medical conditions that make your blood clot poorly
  • Bleeding disorder
  • Recurrent falls
  • Repeated head injury
  • Age – very young or very old
  • Bulging of the “soft spots” of the baby’s skull
  • Feeding difficulties
  • Seizures
  • High-pitched cry
  • Increased head circumference
  • Increased sleepiness or lethargy
  • Irritability
  • Persistent vomiting
  • Separated sutures (the areas where growing skull bones join)

Thorough neurological and physical examination of the patient along with diagnostic tests helps the physician to evaluate the hematoma.

Diagnostic tests

  • CT scan
  • MRI scan
  • Angiography