A subdural hematoma is a blood clot that develops near the brain. These blood clots are known as subdural hematomas because they form under the dura, which is the protective covering of the brain. Hematomas usually require removal because they can compress brain tissue and cause life-threatening complications. In some cases, a hematoma can be successfully drained by creating a small perforation in the skull called a "burr hole." But, when the subdural hematoma is larger or more severe, an open surgical procedure known as a craniotomy is required.
Causes of Subdural Hematoma
Subdural hematomas may result from significant head trauma or a minor head injury, particularly in those with other risk factors. Risks for developing a subdural hematoma include the following:
- Older age
- Use of anticoagulant medications
- Excessive alcohol consumption
- Repetitive injuries to the head
In patients with a chronic subdural hematoma, the blood clot might form and expand over time, initially causing few or no symptoms.
Symptoms of Subdural Hematoma
Patients with a subdural hematoma may experience a wide range of symptoms which include the following:
- Behavioral changes
Sometimes, no symptoms are present initially following the injury and only become noticeable days afterward as the hematoma grows.
Diagnosis of Subdural Hematoma
If a subdural hematoma is suspected, a series of tests may be recommended to confirm a diagnosis. After evaluating a patient's medical history and performing a physical examination, a CT scan or MRI scan may be performed to produce internal images of the brain. In some cases, an angiography is performed using dye to highlight blood flow around the brain.
Treatment of Subdural Hematoma
Surgery is usually the most effective approach for the treatment of a subdural hematoma. There are different types of surgery used for treating this condition.
Burr Hole Drainage
Burr hole drainage requires the use of a special surgical drill to create a small perforation in the skull. The dura is cut open to reveal the hematoma. Irrigation is employed to rinse the area out. The surgeon will then thoroughly drain the region, with the use of tubing to ensure that the blood clot and any excess fluid has been removed.
A craniotomy is a surgical procedure that involves opening up the skull in order to remove the hematoma. Depending on its location, complete removal may be difficult. Craniotomy is a complex procedure that has risks and complications. It may damage normal brain tissue, which can cause problems with brain function, vision and speech.
Patients are generally required to remain in the hospital for several days following surgery for a subdural hematoma. A patient's activities may be restricted for the first few weeks after surgery, and they are advised to avoid any strenuous forms of exercise or activities that might result in a head injury. Many of the symptoms typically experienced with a subdural hematoma, such as headaches, numbness, weakness and speech issues, are often resolved immediately after surgery. Some patients may require rehabilitation services to restore their previous functionality.