Subdural Hematoma

WHAT YOU SHOULD KNOW

A subdural hematoma is a pocket of blood in the space between the brain and the tough membrane that surrounds it (the dura mater).

Causes

The bleeding that feeds a subdural hematoma can be rapid (after a severe blow to the head) or gradual (after a less serious head injury). In either case, trauma causes the blood vessels in the head to rupture and leak, ultimately forming a pool of blood that creates pressure on the brain.

Signs/Symptoms

In cases that develop gradually (chronic subdural hematoma), early warning signs include persistent headache, fluctuating drowsiness, confusion, memory changes, difficulty speaking, and mild paralysis on one side of the body. These symptoms may come and go over a period of several weeks, but will eventually get worse if not treated. Since the symptoms can be confused with those of a stroke, be sure to tell your doctor if you have recently suffered a head injury, even if only slight.

In acute cases, the symptoms are immediate and dramatic, often leading to convulsions and coma.

Care

Small subdural hematomas in otherwise healthy adults usually clear up on their own, as surrounding tissues reabsorb the blood. However, in infants and the very elderly, whose blood vessels are especially fragile, steady leakage can lead to a slowly expanding chronic hematoma that ultimately needs medical treatment. Acute hematomas, such as those sustained in an auto accident, require immediate emergency care.

To make certain he's dealing with a hematoma, your doctor will probably order one of the newer types of internal images, such as a CT scan or an MRI. To reduce swelling and pressure on the brain, he's likely to prescribe a water pill (diuretic). Because of the danger of seizures, an anticonvulsant drug may also be prescribed. If bleeding is severe, surgery (craniotomy) may be required to drain the hematoma and relieve pressure on the brain.

Risks

A subdural hematoma is a very serious, often life-threatening condition. Acute cases after severe trauma are often fatal, sometimes despite prompt medical attention. Chronic cases, although less serious, can cause long-term brain injury or death if left untreated.

WHAT YOU SHOULD DO

Especially in infants and the elderly, any head trauma or injury, no matter how slight, is reason for a trip to the doctor.

Seek Care Immediately If...

• You experience any of the following:
• • Headaches that may be steady or may come and go
  • Confusion
  • Seizures
  • Difficulty breathing, speaking, or swallowing
  • Enlargement of a single pupil
  • Vision changes
  • Eye pain

Do not drive yourself!

IF YOU'RE HEADING FOR THE HOSPITAL

What to Expect While You're There

You may encounter the following procedures and equipment during your stay.

• Taking Vital Signs: These include your temperature, pulse, blood pressure, and respiration. A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm. These tests may be performed hourly.
• Oxygen: Your body may need extra oxygen. It is given by either a mask or nasal prongs.
• Pulse Oximeter: This is a clip placed on your ear, finger, or toe and connected to a machine that measures the oxygen in your blood.
• Neuro Signs: The doctor will check your eyes, assess your memory, and test how easily you awaken. These tests indicate how well your brain is handling the injury.
• IV: A tube placed in your vein for giving medications or liquids. It will either be capped or have tubing connected to it.
• Blood: Taken from a vein in your hand or the bend in your elbow to be used for testing. Blood gases will also be evaluated, therefore additional blood may need to be drawn from either the wrist, elbow, or groin.
• CT Scan: Computerized axial tomography, also know as a CAT scan, provides a type of x-ray of your brain.
• MRI: This procedure also provides pictures of the brain.
• ECG: Also known as a heart monitor, an electrocardiograph, or an EKG. Patches are placed on your chest and then hooked up to a TV-type screen which shows a tracing of each heartbeat. Doctors use this tool to watch for signs of heart trouble that could be related to your head trauma.
• EEG: This is a brain wave study which doctors use to detect damage to the brain that may not show up during other tests. Also known as an electroencephalogram.
• Surgery: To drain the hematoma and relieve pressure on the brain, the doctor may need to cut through the skull. The procedure is performed under general anesthesia. Your hair is shaved where the procedure will take place, an incision is made through the scalp, a small piece of bone is removed. Afterwards, it is replaced and the scalp is stitched.

After You Leave

• Be sure to take your medications exactly as prescribed. Do NOT take any other drugs without first consulting your doctor.
• Rest in bed, stay warm, and limit your normal activities as much as possible for a few days.
• You may also need to limit your diet to liquids.
• Plan to have someone with you at home for at least the first day to wake you every few hours and watch for any symptoms such as those listed under "Seek Care Immediately."
• If you have undergone surgery to drain the hematoma, your recuperation will take longer. Carefully follow your doctor's instructions regarding wound care to ensure that the scalp incision heals properly. Keep the area dry and change the dressing regularly.

Call Your Doctor If...

You continue to have any symptoms of subdural hematoma, such as seizures or persistent headaches.