Subdural hematoma is a type of brain bleed that occurs when a blood vessel tears between the skull and the brain's surface, causing blood to accumulate in the subdural space. It can be caused by a head injury or other factors, such as aging, blood thinners, or alcohol abuse.

Subdural hematoma can be classified into three types, based on how fast they develop and how severe they are:

1). Acute subdural hematoma: This is the most dangerous type, which occurs within minutes to hours after a severe head injury. It causes rapid pressure on the brain, leading to symptoms such as headache, confusion, nausea, vomiting, slurred speech, and loss of consciousness. It requires immediate medical attention and surgery to remove the blood and relieve the pressure. It has a high mortality rate and a poor prognosis.

2). Subacute subdural hematoma: This type occurs within days to weeks after a mild to moderate head injury. It causes gradual pressure on the brain, leading to symptoms such as headache, drowsiness, weakness, and personality changes. It may require surgery or medication to treat the bleeding and prevent complications. It has a better prognosis than acute subdural hematoma, but still carries a risk of permanent brain damage or death.

3). Chronic subdural hematoma: This type occurs within weeks to months after a minor head injury, often in older adults or people with chronic medical conditions. It causes mild pressure on the brain, leading to symptoms such as headache, memory loss, confusion, and seizures. It may not require surgery, but may need medication or drainage to treat the bleeding and prevent recurrence. It has the best prognosis among the three types, but still can cause serious neurological problems or death.

The diagnosis of subdural hematoma is based on a medical history, a physical examination, and some diagnostic tests, such as X-rays, CT scan, MRI, or blood tests.

The treatment of subdural hematoma depends on the type, size, and location of the bleeding, as well as the patient's age, health, and symptoms. Some common treatments are surgery, medication, or observation.

The prevention of subdural hematoma involves avoiding head injuries, wearing protective gear, managing medical conditions, and limiting alcohol intake.

SYMPTOMS OF SUBDURAL HEMATOMA

The symptoms of a subdural hematoma depend on how fast it develops, how much blood accumulates, and how much pressure it puts on the brain. Some common symptoms are:

• Headache that keeps getting worse or does not go away.

• Confusion, drowsiness, or difficulty staying awake.

• Nausea, vomiting, or loss of appetite.

• Slurred speech, vision problems, or difficulty swallowing.

• Weakness, numbness, or paralysis on one side of the body.

• Seizures, loss of consciousness, or coma.

A subdural hematoma can be a serious and life-threatening condition that requires immediate medical attention. If you or someone you know has a head injury or any of the symptoms listed above, please seek emergency care as soon as possible.

CAUSES OF SUBDURAL HEMATOMA

It can be caused by a head injury or other factors that affect blood clotting or increase the risk of bleeding. Some of the possible causes of a subdural hematoma are:

• Trauma to the head, such as from a car crash, fall, or violent assault.

• Aging, which can cause the brain to shrink and the blood vessels to stretch and become more fragile.

• Alcohol misuse, which can also cause the brain to shrink and impair blood clotting.

• Anticoagulant ("blood-thinning") medicine, such as aspirin or warfarin, which can make bleeding more severe.

• Poor blood clotting conditions, such as hemophilia or liver disease.

• Having a ventriculoperitoneal shunt, a tube implanted in the brain to drain excess fluid.

• Brain aneurysms, bulges in the brain's blood vessels that can burst and cause bleeding.

• Brain tumors, abnormal growths of cells in the brain that can compress or damage blood vessels.

RISK FACTORS FOR SUBDURAL HEMATOMA

Some of the risk factors for developing a subdural hematoma are:

• Trauma to the head, such as from a car crash, fall, or violent assault. This is the most common cause of subdural hematoma, especially in young adults.

• Aging, which can cause the brain to shrink and the blood vessels to stretch and become more fragile. This increases the chance of bleeding from minor head injuries, especially in older adults.

• Alcohol misuse, which can also cause the brain to shrink and impair blood clotting. This can make bleeding more severe and harder to stop.

• Anticoagulant (blood-thinning) medicine, such as aspirin or warfarin, which can make bleeding more severe and harder to stop. People who take these medicines should be careful to avoid head injuries and monitor their blood tests regularly.

• Poor blood clotting conditions, such as hemophilia or liver disease, which can make bleeding more severe and harder to stop. People who have these conditions should be careful to avoid head injuries and seek medical attention if they have any symptoms of bleeding.

• Having a ventriculoperitoneal shunt, a tube implanted in the brain to drain excess fluid. This can increase the risk of bleeding from minor head injuries or infections.

• Brain aneurysms, bulges in the brain's blood vessels that can burst and cause bleeding. These are rare but can occur in people with certain genetic conditions or high blood pressure.

• Brain tumors, abnormal growths of cells in the brain that can compress or damage blood vessels. These are also rare but can occur in people of any age.

TREATMENT FOR SUBDURAL HEMATOMA

The treatment for subdural hematoma depends on the type, size, and severity of the bleeding. Some people may only need careful monitoring, while others may require urgent surgery to remove the blood and reduce the pressure on the brain. There are two main types of surgery for subdural hematoma: craniotomy and burr holes.

i). Craniotomy is a procedure where a section of the skull is temporarily removed to access and remove the hematoma. This is usually done for acute subdural hematomas that develop soon after a severe head injury.

ii). Burr holes are small holes drilled into the skull to drain the hematoma. A tube may be inserted through the hole to help drain the blood. This is often done for chronic subdural hematomas that develop days or weeks after a minor head injury.

Both types of surgery are performed by a neurosurgeon, a specialist in surgery of the brain and nervous system. Surgery for subdural hematoma carries some risks, such as infection, further bleeding, seizures, or stroke. Sometimes, not all of the hematoma can be removed and some symptoms may persist or worsen. In some cases, the hematoma may come back and require another surgery. After surgery, you may need to stay in the hospital for a few days or weeks, depending on your condition and recovery. You may also need medication and rehabilitation to help you regain your normal activities.

THE PROGNOSIS FOR SUBDURAL HEMATOMA

The prognosis for subdural hematoma depends on several factors, such as the type, size, and location of the bleeding, the severity of the brain injury, the age and health of the patient, and the timeliness and effectiveness of the treatment. Some general points about the prognosis are:

• Acute subdural hematomas have high rates of death and brain injury, especially if they are large or cause significant pressure on the brain. The mortality rate can range from 36% to 79%, and the survivors often have permanent neurological impairments.

• Chronic subdural hematomas have better outcomes in most cases, as they tend to be smaller and cause less pressure on the brain. The mortality rate can range from 5% to 30%, and the recovery rate can be as high as 80%. However, some patients may have recurrent bleeding or complications from surgery, such as infection, further bleeding, seizures, or stroke.

The prognosis also depends on the patient's age and health status. Older patients, those with poor blood clotting conditions, those who misuse alcohol, and those who take anticoagulant medicines have a higher risk of developing subdural hematomas and worse outcomes. Younger patients, those with mild head injuries, and those who receive prompt and appropriate treatment have a better chance of recovery.

The prognosis can vary from person to person, and some patients may have unexpected or delayed complications or improvements. Therefore, it is important to follow up with your healthcare provider regularly and report any new or worsening symptoms. You may also need medication and rehabilitation to help you regain your normal activities and functioning.

PREVENTION OF SUBDURAL HEMATOMA

To prevent subdural hematoma, you should:

• Avoid activities that may cause head trauma, such as driving under the influence, playing contact sports without proper protection, or working at heights without safety equipment.

• Take precautions to prevent falls, especially if you are elderly, have balance problems, or have seizures.

• Follow your doctor's instructions if you are taking anticoagulant ("blood-thinning") medicines, such as aspirin or warfarin. Monitor your blood tests regularly and report any signs of bleeding or bruising.

• Seek medical attention if you have a head injury or any symptoms of subdural hematoma, such as headache, confusion, drowsiness, nausea, vomiting, slurred speech, weakness, numbness, vision problems, seizures, or loss of consciousness

🔅 The Recovery Process of Subdural Hematoma

The recovery process of subdural hematoma depends on several factors, such as the type, size, and location of the bleeding, the severity of the brain injury, the age and health of the patient, and the timeliness and effectiveness of the treatment. Some general steps involved in the recovery process are:

• Some people may need surgery to remove the blood and reduce the pressure on the brain. There are two main types of surgery for subdural hematoma: craniotomy and burr holes. Craniotomy is a procedure where a section of the skull is temporarily removed to access and remove the hematoma. Burr holes are small holes drilled into the skull to drain the hematoma. A tube may be inserted through the hole to help drain the blood.

• Medication: Some people may need medication to prevent or treat complications, such as seizures, infections, or inflammation. Anticonvulsants are used to prevent seizures. Antibiotics are used to treat infections. Corticosteroids are used to decrease any brain inflammation.

• Monitoring: Some people may need to stay in the hospital for a few days or weeks, depending on their condition and recovery. They may have some follow-up appointments and brain scans to check if the hematoma has returned or if there is any brain damage. Sometimes, surgery may need to be repeated if the hematoma comes back.

• Rehabilitation: Some people may need further treatment and support to help them return to their normal everyday activities. This is known as rehabilitation. A number of different healthcare professionals may be involved in the rehabilitation, such as physiotherapists, speech and language therapists, occupational therapists, and psychologists. They can help with movement problems, speech and communication problems, everyday tasks, and psychological issues.

Some people may need to take some precautions and make some lifestyle changes to prevent another subdural hematoma or improve their recovery. These include getting plenty of sleep and rest, avoiding physically or mentally demanding activities, avoiding alcohol, not operating heavy machinery or driving, and staying away from risky activities that may cause head trauma.

The recovery process of subdural hematoma can vary from person to person, and some people may have unexpected or delayed complications or improvements. Therefore, it is important to follow up with your healthcare provider regularly and report any new or worsening symptoms.

🔅 Can you have a subdural hematoma without head injury?

Yes, it is possible to have a subdural hematoma without a head injury, but it is very rare. Most subdural hematomas are caused by trauma to the head, such as from a car crash, fall, or violent assault. However, some factors can increase the risk of bleeding in the subdural space without an obvious head injury.

If you have any of these risk factors, you should be careful to avoid head injuries and seek medical attention if you have any symptoms of a subdural hematoma, such as headache, confusion, drowsiness, nausea, vomiting, slurred speech, weakness, numbness, vision problems, seizures, or loss of consciousness.

🔅 How common is subdural hematoma?

Subdural hematoma (SDH) is a type of brain bleed that occurs when a blood vessel tears and leaks blood into the space below the outermost layer of the brain. The incidence of SDH varies depending on the type, cause, and population. According to some studies, the overall incidence of SDH ranges from 1.72 to 20.6 per 100,000 persons per year. However, the incidence is higher in certain groups, such as the elderly, those with head trauma, those with bleeding disorders, and those taking anticoagulant or antiplatelet medicines.

SDH is more common in men than in women, and more common in winter than in summer.

SDH is a serious and potentially life-threatening condition that requires immediate medical attention.