Subdural Hematoma: Symptoms, Causes, Treatments

By Dr. Kapil Jain in Neurosciences

Jul 22 , 2022 | 2 min read

What is a Subdural Hematoma?

Subdural hematoma refers to the pooling of blood between the skull and brain. Subdural hematomas compress the brain, give rise to symptoms, and damage the brain as they compress vital brain structures. Subdural hematomas usually occur after head injury and can be life-threatening.

Why does Subdural Hematoma happen?

The bleeding in a subdural hematoma is outside the brain, not in the brain. Hematomas are often caused by head injuries, such as falls, road traffic accidents, or an assault. When a blow to the head stretches and tears blood vessels around your brain, this is known as an acute subdural hematoma.

A chronic subdural hematoma may occur after a stroke, as the result of a brain lesion, or for no apparent reason. The blood leaks out of blood vessels and accumulates between the brain and skull bone, and when the size of hematoma increases, it increases the pressure inside the brain and gives rise to symptoms. 

Understanding Chronic Subdural Hematoma

A chronic subdural hematoma usually occurs in older adults, progresses slowly and can be caused by even minor trauma to the head, which is even not remembered. As we age, brain atrophy occurs. Blood vessels that pass from the brain to the skull stretch and are at risk for tears.

The vessels can rupture with any sudden jerking movement or injury to the head. A minor leaking of blood may go unnoticed, but repeated leaks can cause symptoms and can be dangerous. Antiplatelet and blood thinner medication may make the problem worse. Subdural hematoma may occur without a head injury if a weak artery bursts.

Chronic Subdural Hematoma Symptoms

A chronic subdural hematoma can lead to symptoms due to intracranial pressure or local pressure over the brain. The following symptoms may appear:

  1. Sleepiness, altered conscious level 

  2. Difficulty in speaking or understanding or slurred speech

  3. Headache- mild or severe

  4. Nausea or vomiting

  5. Difficulties with walking or balance

  6. Weakness in any of the limbs - Inability to move parts of the body

  7. Memory disturbances

  8. Numbness anywhere in the body

  9. Sudden changes in mood, personality, or cognition; these signs are especially troubling in the elderly, even if they have dementia

  10. Seizures (Fits)

  11. Changes in vision or hearing

Subdural Hematoma Treatment Options

There are two treatment goals when managing subdural hematomas:

  1. Look for the cause of subdural hematoma- blood thinner, antiplatelet medication, trauma or tumour

  2. Small or symptomless subdural hematomas may need only medical management and do not require surgery. For larger hematoma-causing symptoms, surgery is often needed. 

Two widely used surgical techniques to treat subdural hematoma include Burr hole drainage and Craniotomy. Which surgery is to be done is decided by the Neurosurgeon, depending on the radiology CT/ MRI of the head.

  1. Craniotomy with endoscopic evacuation

A small window is made in the skull, an endoscope is inserted, and the hematoma is removed.

  1. Burr Hole Drainage

A small hole is made in the skull, and the hematoma is removed.

Chronic subdural hematoma is usually observed in old age patients, and their family is afraid of surgery, but with the advancement in medical science and surgical technology, surgery is safe and is associated with negligible risk. Surgery can be performed under sedation without general anaesthesia.