Subdural Hematoma Definition
Subdural hematoma or also called subdural hemorrhage is a condition when blood builds up between two layers in the brain, namely the arachnoid layer and the dura or meningeal layer.
Subdural Hematoma Types
Subdural hematoma (SDH) based on the Brain Trauma Foundation is divided into acute and chronic lesions. The Brain Trauma Foundation defines acute subdural hematoma (SDH) as an SDH diagnosed in less than 14 days after a traumatic brain injury. Whereas if it is above 14 days it is referred to as Chronic SDH .
Based on the time of the event and the CT scan picture, SDH is divided into 3 parts [1.3]:
- Parenchymal lacerations (generally in the frontal or temporal lobes)
- Bridging vein or superficial vein tear when an acceleration force occurs – cerebral deceleration due to a great head impact .
Chronic SDH is most commonly found in older people over the age of 63 years. The brain in the elderly generally experiences mild brain atrophy, resulting in a larger subdural cavity, as a result of which a small impact in the elderly can be at risk of SDH. Patients who consume anticoagulant therapy for a long time also have a high risk factor of chronic SDH.
In some cases, SDH is not always caused by a head collision, there is a term for spontaneous SDH. Some of the risk factors of spontaneous SDH include hypertension, vascular abnormalities, tumors, infections, alco**holics, hypovitaminosis, coagulopathy, intracranial hypotension (post epidural anesthesia, lumbar puncture, VP shunt), and history of anticoagulant treatment.
Subdural Hematoma Risk Factors
Certain factors can increase the risk of developing subdural hematoma:
- Anticoagulant medications (blood thinners, including aspirin).
- Long-term alco**hol abuse.
- Medical conditions that make the blood clot.
- Falls repeatedly.
- Repeated head injuries.
- Very young or too old.
Subdural Hematoma Causes
In most cases, this subdural hematoma appears due to severe head injury. In this condition, blood will fill the brain area quickly. This condition is what can eventually lead to acute subdural hematoma.
In addition to severe head injuries, subdural hematomas can also occur as a result of minor head injuries. This condition generally occurs in the elderly because the blood vessels have generally loosened due to brain atrophy. It is possible that this condition has not been known for several days, even weeks. In the medical world this condition is called “chronic” subdural hematoma.
What are the signs and symptoms of a subdural hematoma?
Symptoms of subdural brain hemorrhage can appear immediately or even a few weeks after the injury.
That’s why, some people may look fine after an injury.
However, high pressure on the brain that continues to be left unchecked can cause:
- Severe headache,
- Nausea and vomiting,
- Disorientation (drowsiness, confusion, daze),
- Changes in behavior,
- Weakness on one side of the body, as well as
- Loss of consciousness or coma.
In many cases, chronic subdural hematoma symptoms can be similar to those of dementia, stroke, tumors, or other problems in the brain.
If this condition occurs in infants, symptoms may include:
- Fontanelle (soft part of the baby’s skull) protrudes,
- Difficulty eating,
- The enlarged head,
- Always look sleepy (lethargy),
- Easily angry, and
- Vomiting continuously.
If you have any of the above signs or symptoms or other questions, consult a doctor.
Each person’s body is different. Therefore, always consult a doctor for a more accurate examination.
- Greenberg MS. Handbook Of Neurosurgery. Seventh edition. New York: Thieme Medical Publisher, Inc; 2010.
- Brain Trauma Foundation. Surgical Management of Acute Subdural Hematomas. 2006. Page: 16-20.
- Kaye AH. Essential Neurosurgery. 3rd edition. Massachusetts: Blackwell Publishing LTD; 2005.
- Image: Lucien Monfils, CC BY-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0, via Wikimedia Commons
- Video: James Smirniotopoulos