(Extra-axial Haematoma; Subdural Haemorrhage; SDH)
DefinitionA hematoma is a collection of blood. A subdural hematoma develops in the space between the covering of brain (the dura) and the inside of the skull. This pool of blood can put pressure on the brain and cause a range of symptoms.
CausesA subdural hematoma is most often caused by a head injury. The injury may be caused by traumas such as falls, car accidents, or physical abuse. It can also occur spontaneously.
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Risk FactorsFactors that increase your risk of a subdural hematoma include:
- Increased age—greater risk of falls and weaker blood vessels
- Playing high-impact sports
- Taking blood thinning medication
- Having atrial fibrillation
- Having a history of heart attack
- Abusing alcohol or drugs
SymptomsThe blood may pool quickly or take some time to build up. This will affect how fast symptoms develop. The subdural hematoma may be:
- Acute—symptoms appear soon after the injury
- Subacute—symptoms appear a few days after the injury
- Chronic—bleeding is slower and symptoms only appear weeks after the injury
- Loss of consciousness
- Bruising around the head or eyes
- Nausea or vomiting
- Personality changes
- Limb weakness
- Speech difficulties
- Vision problems
DiagnosisYour doctor will ask about your symptoms and medical history. A physical exam will be done. You may also be referred to a specialist for additional testing.Imaging tests evaluate the brain and surrounding structures. This can be done with:
- Neurological examination
- Electroencephalogram EEG—to measure your brain's electrical activity
- Neuropsychological testing
TreatmentTalk with your doctor about the best treatment plan for you. Treatment will depend on the size and severity of the hematoma. It will also be based on your specific symptoms.Treatment options include the following:
Monitor and ObserveA minor injury with little or no symptoms may not need treatment. Your doctor may simply ask that you watch for any new symptoms. It can take days and weeks for some symptoms to develop.
MedicationsMedication may be given to relieve symptoms. Some medications may include:
- Antiseizure medication—if seizures have occurred
- Steroids—to decrease brain swelling.
SurgerySurgery may be needed to relieve pressure on the brain. Surgical procedures that may be considered include:
- A small hole may be made in the scalp and skull. It will allow the blood clot to drain out of the skull.
- A section of the skull may be removed. This is called a craniotomy .
PreventionTo help reduce your chance of head injury, take these steps:
- Wear proper helmets when playing sports and riding a bike or motorcycle.
- Use a seat belt while traveling in car.
- Reduce the risk of a fall or injury. Safeguard your home and workplace.
- Have regular blood tests if you are taking blood thinning medication.
- Limit your alcohol intake to a moderate level. This means:
- Two or fewer drinks per day for men
- One or fewer drinks per day for women
American Academy of Otolaryngology, Head and Neck Surgery
Brain Injury Association of America
The Brain Injury Association of Canada
Ontario Brain Injury Association
Servadei F, Compagnone C, et al. The role of surgery in traumatic brain injury. Curr Opin Crit Care. 2007;13:163-168.
Subdural hematoma. EBSCO Dynamed website. Available at: http://www.ebscohost.com/dynamed. Updated March 17, 2014. Accessed June 2, 2014.
Subdural haematoma. Patient UK website. Available at: http://www.patient.co.uk/showdoc/27001513. Updated September 28, 2011. Accessed June 2, 2014.
- Reviewer: Rimas Lukas, MD
- Review Date: 05/2014
- Update Date: 06/02/2014
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