Treatment of Subdural Brain Hematoma

About the disease

Subdural brain hematoma is a condition, when blood builds up outside the brain. Bleeding usually occurs between the layers of tissues that surround the brain. Such bleeding creates pressure on the brain, which can result in loss of consciousness or even death, that's why subdural hematomas are so dangerous. It is usually caused by head injuries or traumas, when blood vessels that run over the brain are torn. Subdural brain hematoma can occur after a sharp blow on the head, fall or car crash. According to American site MedScape, 72% cases of acute brain hematoma are caused by falls and assault and 24% by car accidents. There are two types of subdural hematoma: acute and chronic. Chronic brain hematoma can develop in people with bleeding disorder or caused by blood thinning drugs. Chronic brain hematoma can also be caused by shrinkage of brain, common only in the elderly.

Symptoms

• Headache
• Sudden loss of consciousness
• Confusion
• Dizziness
• Nausea
• Behavioral changes
• Drowsiness
• Apathy
• Seizures

In most cases such symptoms appear in the matter of 72 hours after a person experienced head injury. In some cases subdural hematoma can develop 3-7 days before it becomes apparent. Chronic hematoma can be latent for several weeks before manifesting itself. 

Diagnosis

• MRI or CT scan are the most usually used diagnostic devices, as they can create the image of the brain and show if there is buildup of blood in its tissues. They also create images of the skull.
• X-Ray of the skull can also show changes in the brain, which can occur because of subdural hematoma.
• Angiography is used much more rarely. During this procedure a catheter is inserted into the groin and then threaded to the brain to show the blood flow.

Treatment

If subdural hematoma is not severe and diagnosis confirmed that it is not dangerous, person may only have to stay in the hospital for observation until hematoma disappears on its own. During this period patient needs to undergo continuous imaging tests to control the hematoma.  

• Craniotomy and surgical removal of the hematoma is used to reduce the pressure on the brain and remove the blood buildup. During the procedure part of the skull is temporarily removed to let the surgeon access the hematoma.
• Burr hole trephination is a procedure, when a hole is made in the skull to suck out blood excess.
• Surgical decompression of the brain is recommended if the size of hematoma exceeds 1 cm in thickness.

Overall, you will have to stay in the hospital for several days after the surgery to completely restore all of your brain functions.

Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko