Subdural Hematoma



This is caused usually by injury to the front or back of the head. It produces a tear of the lining of the brain or of the vessels as they enter the brain substance. Blood accumulates between the brain itself and the bony cranium. It occurs mainly in older people in the 50-and-over age group, but may also occur in younger persons. The blood clots, and later the internal parts liquefy and may absorb additional fluid from the brain fluids. The mechanical pressure of this mass on the brain will ultimately produce symptoms.

Subdural Hematoma Symptoms

There is nearly always a history of injury, but it is emphasized that this is often trivial. Considerable time may elapse, with varying symptoms often difficult to interpret, before the suspicion of a hematoma occurs.



It may take days to weeks or months before symptoms occur. The time lapse is shorter in younger people and the symptoms are often more dramatic. Usually there is a definite history of accident often in sports or falls.

Headaches are the most common initial symptom, often severe, on wakening in the morning or after exertion. Other symptoms develop, such as lapsing into stupor or coma, to awaken with almost normal feelings. Mental confusion may occur. Gradually the symptoms increase in intensity



New diagnostic techniques may quickly identify the trouble. Brain scans, ultrasonograms and the CT scan or MRI can quickly and accurately give a diagnosis and localize the lesion.

Unless diagnosis is made and treatment undertaken, the outcome is often fatal. Newer techniques, if available, may assist in the diagnosis. Treatment (and perhaps diagnosis) involves repeated tapping of the cranium with trephine holes through which the blood clot may be sucked out. Sometimes a flap of bone is lifted from the cranium and the clot removed in this manner. Recognition and treatment of a subdural hematoma is usually dramatic and curative.



A variety of other conditions may occur in this category, but in principle they are covered, and for practical purposes the chief ones have been described.

Hypertensive cephalopathy may take place. This happens when the blood pressure in a patient already suffering from high blood pressure rises still further. A stroke does not result, but headache, sickness, drowsiness and maybe coma could follow. A crisis lasting from hours to days may occur, and then the patient may recover again. This is an emergency measure that must be treated in hospital.