A subdural hematoma is a bleeding of the brain and usually occurs as a result of head injury. There is a distinction between acute and chronic subdural hematoma, and symptoms are the same in both cases but may occur at different rates. Prompt diagnosis is particularly important, as life-threatening complications may result.
What is a subdural hematoma?
Subdural hematomas usually occur because of a head injury and can sometimes be life-threatening. It is a cerebral hemorrhage that is located in the calvaria of the skull on the surface of the brain. There is a distinction between an acute and a chronic form. An acute subdural hematoma occurs due to a serious head injury and a chronic one can occur as a result of a lighter head injury or increased falls. The term is also used to describe blood clots on the surface of the brain. These can occur as a result of congenital vascular malformations or due to risk factors such as hypertension, smoking, or obesity.
Causes
As soon as a rupture, or bursting of the vein, occurs between the skull and the brain surface, the so-called subdural hematomas develop. Thus, a severe head injury may cause the space between the brain and the skull to fill with blood. This acute subdural hematoma is among the most dangerous of its kind, as it can cause life-threatening symptoms. Acute subdural hematomas occur largely due to a blow or impact to the head, from falls, or usually from car accidents. These hematomas occur immediately along with the symptoms. Chronic subdural hematomas, on the other hand, develop slowly. Mild or repetitive head injuries are considered the cause. It is therefore common for older people to be affected if there have been multiple falls. Symptoms usually appear later, sometimes even several weeks in between, and are therefore not recognized immediately. Treatment is easier, although life-threatening complications can still occur.
Symptoms, complaints, and signs
Symptoms of subdural hematoma appear immediately in the acute form and delayed or not at all in the chronic form. However, recognizing the symptoms is extremely important in order to seek timely treatment. The most common symptoms are headaches, speech disorders and convulsions. Visual disturbances, numbness, loss of strength and loss of consciousness can also be
Loss of consciousness can make themselves felt as accompanying symptoms.
Diagnosis and course of the disease
To diagnose a subdural hematoma, an MRI (magnetic resonance imaging) or CT (computed tomography) scan is necessary. In addition, a CBC looking at red and white blood cell counts may provide information, as an insufficient red blood cell count indicates severe blood loss. Sometimes a physical examination may also be performed, and blood pressure and pulse checked, as these factors may indicate internal bleeding.
Complications
A subdural hematoma can cause a number of complications and, in isolated cases, may have late sequelae. In most cases, intracranial pressure increases in those who have suffered a traumatic brain injury. This can lead to coma or death. Furthermore, seizures can occur, which are associated with an increased risk of accidents. In the case of major injuries, muscle weakness or numbness in certain areas of the body is also conceivable. Typical late effects of a subdural hematoma are limitations in mental performance and neurological disorders. As a result of trauma, some patients also develop mental disorders such as anxiety disorders or depression. Because surgical treatment of a subdural hematoma is a complicated procedure, minor and major complications can occur. Potential risks of craniotomy include bleeding and bruising, as well as infection and wound healing problems. Occasionally, blood clots form, which can cause convulsions and possibly lead to death. Specific risks associated with cranial opening include injury to healthy brain tissue, leakage of cerebrospinal fluid, and accumulation of air in the cranial cavity. Anesthesia may also be associated with adverse events. For example, sudden heart failure may occur.
When should you go to the doctor?
After a head injury, careful consideration should be given to whether persistent or increasing discomfort is present. In the case of minor injuries, it is not always necessary to see a doctor. If discomfort diminishes almost completely within a few minutes, there is usually no need for further treatment. However, if there is a feeling of illness, dizziness or unsteadiness of gait, consultation with a physician is necessary. Headaches, bleeding or damage to the skull bone should be examined and treated. Regardless of whether the injury to the head was caused by a fall, bump, accident, or force, damage may be present that, in severe cases, may result in irreversible damage or premature demise of the individual. Therefore, a visit to the doctor is necessary in case of speech disorders, general dysfunction or sudden convulsions. A sudden decrease of vision is to be understood as an alarm signal of the organism. Since some patients may experience the described complaints even without a direct head injury, a physician should also be consulted if irregularities occur without an impact or perceived impact on the head. A sudden loss of strength, numbness or sensory disturbances should also be investigated as soon as possible. If there is any disturbance of consciousness or loss of consciousness, an ambulance must be alerted. In these cases, there is a danger to life, so the affected person needs immediate medical attention.
Treatment and therapy
Treatment of an acute subdural hematoma can only be done in a hospital, as swelling of the brain can occur at any time. This swelling causes increased intracranial pressure, which must be treated without fail by means of special burr holes in the skull. To remove a large subdural hematoma, a so-called craniotomy is performed. This is a surgical procedure, which must be performed especially in acute cases. During this procedure, a portion of the skull is removed and then the blood clot or hematoma is aspirated and flushed out. In the case of smaller hematomas, it is possible to drain them by means of drilled holes. This involves inserting thin tubes into the small holes in the skull, allowing the blood to escape from the hematoma. In addition, brain injuries are also treated with medication, as corticosteroids, for example, can be used to combat inflammation. Treatment or prevention of concomitant symptoms such as convulsions can also be achieved with appropriate medications. Nevertheless, complications of subdural hematomas are not uncommon. These can even occur some time after treatment has taken place. Permanent numbness, muscle weakness, seizures or increasing intracranial pressure may occur. The latter is particularly dangerous, as it can lead to coma or even death. Complications can vary in severity depending on the severity of the skull injury. A prognosis also depends on the severity of the injury, the location and extent of the subdural hematoma. For chronic subdural hematomas, the odds are good, where, on the other hand, the acute form can vary widely. According to the U.S. Department of Neurosurgery ULCA, death occurs in approximately 50 to 90 percent of cases due to the condition or complications.
Prevention
Due to congenital vascular malformations, bleeding in the brain can occur at any time, and prevention is not possible in this case. However, hypertension is also considered a huge risk for brain hemorrhage and can be treated accordingly. Regular medical checks are therefore essential if high blood pressure is already diagnosed. Smoking also increases the risk of brain hemorrhage by a factor of two to three. The same applies to regular, high alcohol consumption, severe obesity and elevated cholesterol levels. Therefore, prevention is definitely possible to reduce the risk of bleeding in the brain. Scheduled doctor visits, a healthy diet, and adequate exercise can go a long way before problems develop.
Follow-up care
Since the disease can quickly lead to impaired thinking and many other symptoms, it is imperative that affected individuals avoid any situations of stress. The body should be sufficiently spared so that these complaints can be prevented.Since the disease is usually accompanied by a head injury, the injury should be sufficiently cooled by affected persons. Cooling packs as well as compresses are very helpful in relieving discomfort and treating swelling. If the condition has already triggered numerous discomforts, sufferers need to undergo physiotherapy. In the case of brain hemorrhages caused by the disease, severe and permanent consequential damage can occur. People suffering from the disease should seek out a support group. It can be very helpful to talk about the disease with other sufferers. This also has the effect of making those affected not feel alone and familiarizing them with methods and practices that show them how to live a largely normal life with the disease. After the brain hemorrhages, a change in the personality of affected persons can also occur as a consequential damage. It is very important for those affected with the disease to see a psychologist. In addition, family members should be sufficiently informed about the disease so that immediate action can be taken in emergencies. The help and support of family members is imperative.
This is what you can do yourself
After a subdural hematoma, thinking difficulties and other neurologic symptoms may continue for some time. The most important self-help measure is to avoid stress and take it easy on the body. Since a subdural hematoma usually occurs in connection with severe head injuries, the head must be cooled in any case. Cooling compresses but also compresses made of curd or medicinal ointments are suitable to relieve any swelling and pain. If the subdural hematoma has caused long-term discomfort, comprehensive physiotherapy is necessary. If the brain hemorrhage is severe, permanent dysfunction may remain. Individuals who have suffered a subdural hematoma benefit from talking with others who have been affected. The doctor can put them in touch with a self-help group and refer them to other specialists and medical professionals if necessary. Personality changes may also occur after severe brain hemorrhage. It is the task of the relatives to support the affected person as much as possible. In addition, attention must always be paid to regular visits to the doctor. In the first months after a brain hemorrhage, brain scans must be taken regularly. If no abnormalities are shown, no other measures need to be taken apart from the typical therapeutic measures.
