Acute Subdural Haematoma:
This page is intended as a patient/relative information source only. It is not a substitute for professional medical advice.
What Is A Subdural Haematoma?
A subdural haematoma is the term used to describe a collection of blood that accumulates under one of the coverings of the brain called the dura. A subdural haematoma is extremely common and in Leeds we see around two hundred cases per year.
There are two main types of subdural haematomas; acute and chronic. Acute means that the bleeding has happened quickly and recently. Chronic means that the blood has been present for some time, often weeks or even months. The rest of this article is about acute subdural haematomas. Information about chronic subdural haematomas can be found here.
What Causes An Acute Subdural Haematoma?
An acute subdural haemorrhage is one that occurs suddenly, progresses quickly and is usually caused by a severe impact to the head. These bleeds occur because blood vessels (usually veins) on the outside of the brain rupture, or some of the outer parts of the brain become bruised and bleed. It occurs in approximately one third of people with a severe head injury. A ‘subacute’ subdural haemorrhage is very similar to an acute subdural, but its progresses at a slightly slower rate.
How Is An Acute Subdural Haematoma Diagnosed?
People with an acute subdural haematoma can be very well, very unwell or anywhere in between. A severe head injury can cause someone to become confused, agitated, or unconscious. If doctors suspect that someone might have a subdural haemorrhage then they will organise a head scan (usually a CT) to obtain images of the brain.
How Is An Acute Subdural Haematoma Treated?
The first part of the treatment of an acute subdural haematoma is focussed on supporting the patient and maintaining their vital functions. This might involve being admitted, monitored and treated on an intensive care or high dependency unit if necessary. Some acute subdural haematomas can be observed and do not require urgent surgery.
If the bleed is sufficiently large then they would be taken to the operating theatre for surgery. If an operation is conducted then it will usually involve a ‘craniotomy’. The operation will entail being put to sleep before some of the hair is shaved and a cut made in the head. A small trap door is made in the skull bone to allow access to the brain (this is the ‘craniotomy’). The surgeon will then attempt to evacuate the clotted blood and ensure that there is no further bleeding.
What Is The Outlook?
Subdural haematoma is often a serious condition and the outcomes can range from very good to very grave. Quick treatment can be a key priority for a good outcome as can a period of rehabilitation with the help of doctors, nursing staff, physiotherapists and occupational therapists.
Patients may develop weakness on one side of the body, seizures, or problems with speech (much like a typical ‘stroke’ picture). Sometimes these symptoms can improve over time with input from the rehabilitation team and medications.
For those with acute subdural haemorrhage the risk of death and disability varies enormously and it is not always possible to predict who will do well and who will do less well. As a general rule, the more poorly someone is prior to surgery, the higher the chances of lasting brain damage after surgery. Sadly, people are sometimes too poorly to tolerate surgery by the time that they reach hospital.
Unfortunately, there are lots of potential complications from subdural haemorrhage but the team in Leeds are well-equipped to deal with these if and when they occur.
Some patients who are admitted with an acute subdural haematoma will be initially treated on our intensive care unit or our high dependency unit, where they can be closely monitored if required.
Page Author: Dr Tom Kilner, March 2011