Subdural hematoma

Subdural Hematoma (SDH) is a type of intracranial hemorrhage, where blood accumulates in the subdural space between the brain's dura mater and the arachnoid mater. It is typically caused by head trauma that leads to tearing of the bridging veins. The condition can be life-threatening and requires prompt diagnosis and treatment.

Trauma subdural arrow

Signs and Symptoms

The signs and symptoms of a subdural hematoma may vary depending on its size, location, and the severity of the injury. They may include:

• Headache
• Confusion or altered mental status
• Dizziness
• Nausea and vomiting
• Weakness or numbness on one side of the body
• Slurred speech
• Loss of consciousness
• Seizures

Causes

Subdural hematomas are most commonly caused by head injuries, such as falls, motor vehicle accidents, and assaults. Other risk factors include:

• Advanced age
• Alcohol abuse
• Blood clotting disorders
• Long-term use of anticoagulants
• Repeated head injuries (e.g., in contact sports)

Diagnosis

To diagnose a subdural hematoma, the following diagnostic tests may be performed:

• Medical history and physical examination: The doctor will ask about any recent head injury, symptoms, and medical history.
• Neurological examination: The doctor will assess the patient's cognitive function, motor skills, and reflexes.
• Imaging studies: A CT scan or MRI of the head can provide detailed images of the brain and detect the presence of a subdural hematoma.

Treatment

Treatment options for subdural hematoma depend on the severity and size of the hematoma, as well as the patient's overall health. They may include:

• Observation: For small, stable hematomas with mild symptoms, the doctor may recommend regular monitoring and follow-up imaging studies.
• Medications: Diuretics, corticosteroids, or antiepileptic drugs may be prescribed to manage symptoms and prevent complications.
• Surgical intervention: For larger hematomas or those causing significant symptoms, surgery may be necessary. Surgical options include:
  • Burr hole trephination: A small hole is drilled into the skull to drain the hematoma.
  • Craniotomy: A section of the skull is temporarily removed to access the hematoma and remove it.
  • Craniectomy: A part of the skull is permanently removed to relieve pressure on the brain.

Prognosis

The prognosis for subdural hematoma depends on various factors, such as the size and location of the hematoma, the patient's age, and the presence of any underlying medical conditions. Early diagnosis and treatment can significantly improve the outcome.

Prevention

Preventing head injuries is the primary method of subdural hematoma prevention. This may involve:

• Wearing helmets during high-risk activities
• Fall prevention measures for the elderly
• Avoiding alcohol abuse
• Regularly reviewing medications with a healthcare provider to minimize the risk of bleeding

References

• Evans, R. W. (2006). Subdural hematoma. In Evans, R. W. (Ed.), Diagnostic testing in neurology (pp. 343-345). Philadelphia, PA: W. B. Saunders Company.
• Murthy, J. M. K. (2016). Subdural hematomas: An overview. Journal of Neurosciences in Rural Practice, 7(Suppl 1), S2-S6. https://doi.org/10.4103/0976-3147.181474
• Shetty, S., & Bharath, R. (2019). Subdural hematoma. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532972/
• Wilberger, J. E., & Maroon, J. C. (2016). Subdural hematoma. In Winn, H. R. (Ed.), Youmans and Winn neurological surgery (7th ed., pp. 3114-3121). Philadelphia, PA: Elsevier.

External Links

• MedlinePlus: Subdural hematoma
• Mayo Clinic: Intracranial Hematoma
• American Association of Neurological Surgeons: Subdural Hematoma

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