A subdural hematoma is a collection of blood between the covering of the brain (dura) and the surface of the brain.
Subdural hemorrhage; Traumatic brain injury - subdural hematoma; TBI - subdural hematoma; Head injury - subdural hematoma
A subdural hematoma is most often the result of a severe head injury. This type of subdural hematoma is among the deadliest of all head injuries. The bleeding fills the brain area very rapidly, compressing brain tissue. This often results in brain injury and may lead to death.
Subdural hematomas can also occur after a minor head injury. The amount of bleeding is smaller and occurs more slowly. This type of subdural hematoma is often seen in older adults. These may go unnoticed for many days to weeks and are called chronic subdural hematomas.
With any subdural hematoma, tiny veins between the surface of the brain and its outer covering (the dura) stretch and tear, allowing blood to collect. In older adults, the veins are often already stretched because of brain shrinkage (atrophy) and are more easily injured.
Some subdural hematomas occur without cause (spontaneously).
The following increase the risk for a subdural hematoma:
In infants and young children, a subdural hematoma may occur after child abuse and are commonly seen in a condition called shaken baby syndrome.
Depending on the size of the hematoma and where it presses on the brain, any of the following symptoms may occur:
In infants, symptoms may include:
A subdural hematoma is an emergency condition.
Emergency surgery may be needed to reduce pressure within the brain. This may involve drilling a small hole in the skull to drain any blood and relieve pressure on the brain. Large hematomas or solid blood clots may need to be removed through a procedure called a craniotomy, which creates a larger opening in the skull.
Medicines that may be used depend on the type of subdural hematoma, how severe the symptoms are, and how much brain damage has occurred. Medicines may include:
Outlook depends on the type and location of head injury, the size of the blood collection, and how soon treatment is started.
Acute subdural hematomas have high rates of death and brain injury. Chronic subdural hematomas have better outcomes in most cases. Symptoms often go away after the blood collection is drained. Physical therapy is sometimes needed to help the person get back to their usual level of functioning.
Seizures often occur at the time the hematoma forms, or up to months or years after treatment. But medicines can help control the seizures.
Complications that may result include:
A subdural hematoma is a medical emergency. Call 911 or your local emergency number, or go to an emergency room after a head injury. Do not delay.
Spinal injuries often occur with head injuries, so try to keep the person's neck still if you must move them before help arrives.
Always use safety equipment at work and play to reduce your risk for a head injury. For example, use hard hats, bicycle or motorcycle helmets, and seat belts. Older individuals should be particularly careful to avoid falls.
Papa L, Goldberg SA. Head trauma. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 34.
Stippler M. Craniocerebral trauma. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 62.