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Brain & Nervous System Health Center

Subdural Hematoma

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Symptoms of Subdural Hematoma

Symptoms of subdural hematoma depend mostly on the rate of bleeding:

  • In head injuries with sudden, severe bleeding causing a subdural hematoma, a person may lose consciousness and enter coma immediately.
  • A person may appear normal for days after a head injury, but slowly become confused and then unconscious several days later. This results from a slower rate of bleeding, causing a slowly enlarging subdural hematoma.
  • In very slow-growing subdural hematomas, there may be no noticeable symptoms for more than two weeks after the bleeding starts.

Symptoms of subdural hematoma can include:

  • Headache
  • Confusion
  • Change in behavior
  • Dizziness
  • Nausea and vomiting
  • Lethargy or excessive drowsiness
  • Weakness
  • Apathy
  • Seizures

People may vary widely in their symptoms of subdural hematoma. Besides the size of the subdural hematoma, a person's age and other medical conditions can affect the response to having a subdural hematoma.

Diagnosis of Subdural Hematoma

People who come to medical attention after a head injury often undergo head imaging, usually with computed tomography (CT scan) or magnetic resonance imaging (MRI scan). These tests create images of the interior of the skull, usually detecting any subdural hematoma present. MRI is slightly superior to CT in detecting subdural hematoma, but CT is faster and more readily available.

Rarely, angiography may be used to diagnose subdural hematoma. During angiography (angiogram), a catheter is inserted into the arteries, special dye is injected, and an X-ray screen shows blood flow through the arteries and veins. 

Treatment of Subdural Hematoma

Treatment of subdural hematomas depends on their severity. Treatment can range from watchful waiting to aggressive brain surgery.

In small subdural hematomas with mild symptoms, doctors may recommend no specific treatment other than observation. Repeated head imaging tests are often performed to demonstrate the subdural hematoma is improving.

More severe or dangerous subdural hematomas require surgery to reduce the pressure on the brain. Surgeons can use various techniques to treat subdural hematomas:

Burr hole trephination. A hole is drilled in the skull over the area of the subdural hematoma, and the blood is suctioned out through the hole.

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