When we hit our head somewhere, we often think, "Oh, it's just a small bump and that's okay," right? But sometimes, especially when we hit our head a little hard, we don't see the damage inside our skull. That's when a very dangerous, even life-threatening condition can occur. This is called a Subdural Hematoma . Simply put, this is when blood collects inside the head, around the brain. Let's talk about this exactly, simply.
What is Subdural Hematoma?
A subdural hematoma is a bleeding inside the brain. Specifically, it is a collection of blood between the layers of membranes that protect our brain. This often happens due to a head injury.
Think of our brain as a precious jewel. There are cushion-like coverings around that jewel to protect it. Similarly, there are three main layers of membranes to protect our brain. We call these `(meninges)`.
- Dura mater: This is the outermost, strong layer beneath the skull.
- Arachnoid mater: This is the middle, delicate layer that resembles a spider's web.
- Pia mater: This is the innermost layer that is attached to the brain itself.
A subdural hematoma occurs when a blow to the head causes a small blood vessel between these layers to rupture. The blood from the ruptured vessel then collects in the space between the outer dura mater and the inner arachnoid mater . This pooling of blood, which forms a blood clot, is called a subdural hematoma. This is a serious condition that falls under the category of Traumatic Brain Injury (TBI).
The blood clot that forms in this way begins to press on the brain. This disrupts brain function. This is a condition that requires emergency medical treatment.
What are the main types of Subdural Hematoma?
Doctors classify this condition based on the speed of onset of symptoms, the amount of bleeding, and the extent of brain damage. This classification is very important in determining treatment.
| Type | Time of onset of symptoms | A simple explanation |
|---|---|---|
| Acute | Within a few minutes to a few hours | This is the most dangerous and sudden type . Symptoms appear after a severe head injury. The blood flow is rapid, so the pressure on the brain increases very quickly. If not treated quickly, it can lead to loss of consciousness, paralysis, or even death. |
| Subacute | From a few hours to a few days or weeks | Symptoms appear gradually. Symptoms may appear two to three days, sometimes up to a week, after a head injury. This condition can occur with a concussion . |
| Chronic | From a few weeks to a few months | This type is most common in people over the age of 65. The bleeding is very heavy, almost like a trickle. Therefore, it can take weeks or months for symptoms to appear. Sometimes, when symptoms appear, you may not even remember that you hit your head. |
What are the symptoms of this condition?
Symptoms may appear immediately after a head injury, or they may appear over time. It depends on the type we discussed above.
Commonly seen symptoms
- A persistent, severe headache: This is especially severe in the `(Acute)` type.
- Nausea and vomiting: Vomiting for no reason.
- Difficulty speaking (Dysarthria): Words are slurred and feel like they are stuttering.
- Vision changes: Blurred vision, double vision.
- Dizziness: Feeling like your head is spinning.
- Difficulty walking and loss of balance: Staggering when walking.
- Weakness on one side of the body: An arm or leg becomes numb or weak.
Symptoms especially seen in the chronic type
- Memory loss: Forgetting recent events.
- Confusion: You can't figure out where you are or what time it is.
- Behavioral changes: Sudden anger and agitation.
If this condition occurs in young babies , their skulls are still soft, so the head may become enlarged as blood accumulates.
Symptoms that may occur when the condition is severe
As blood builds up inside the head and pressure increases, symptoms can become more severe.
- Paralysis
- Seizures
- Difficulty breathing
- Loss of consciousness
- Coma
It's important to note that sometimes there are no symptoms immediately after a head injury. However, symptoms can suddenly appear a few days later. So it's dangerous to just say, "I'm fine" when you get a head injury.
What are the main causes of Subdural Hematoma?
In most cases, this condition is caused by a head injury. For example:
- Slipping and falling in the bathroom and hitting your head.
- Head injury in a bicycle, three-wheeler, or car accident.
- Hitting your head while playing sports like football or rugby.
- Head injuries due to an assault.
Who is at higher risk?
Although anyone can develop this condition after an accident, some people are at a higher risk.
- Age: People over 65 and young children are at higher risk. As we age, our brains naturally shrink a bit. This creates a small gap between the skull and the brain. This can stretch the delicate blood vessels that lead to the brain. Even with a minor fall, these stretched blood vessels can easily rupture and bleed. Since young children's neck muscles are not strong, this condition can occur when they are shaken too hard (shaken baby syndrome) .
- People taking blood thinners: Medications such as anticoagulants, which are used to treat conditions such as heart disease and stroke, control blood clotting. If someone taking these medications hits their head, the bleeding may continue without stopping.
- Certain medical conditions: People with diseases that impair blood clotting, such as hemophilia, are at higher risk.
- Excessive alcohol consumption: Excessive alcohol consumption over a long period of time can damage the liver. The liver produces proteins needed for blood clotting. When the liver is damaged, those proteins stop being produced, increasing the risk of bleeding.
How does a doctor find this?
When you go to the hospital with a head injury, the doctor will first examine you carefully. He will ask you questions like:
- What symptoms are you experiencing?
- How and when did you hit your head?
- What other illnesses do you have?
- What medications do you use?
Then, if there is a suspicion of a subdural hematoma, a head scan will be ordered.
- CT scan (Computed Tomography scan): This can quickly take pictures of the inside of the head to check for bleeding. This is most often done in an emergency.
- MRI scan (Magnetic Resonance Imaging scan): This can take clearer, more detailed pictures. This can help determine the extent of the bleeding and how old it is.
How is it treated?
In an emergency, doctors in the hospital's Emergency Treatment Unit (ETU) will first stabilize your breathing and blood pressure. Then, treatment will be determined based on the amount of bleeding and the severity of your symptoms.
- Surgery: If there is a large blood clot and the symptoms are severe, surgery is usually required. This is done by a neurosurgeon .
- Craniotomy: This involves temporarily removing a small portion of the skull to completely remove the blood clot that has accumulated inside. This surgery is mainly performed for acute hematomas.
- Burr holes: This involves making one or more very small holes in the skull, inserting a thin tube through them, and slowly draining the blood. This method is most commonly used for chronic hematomas.
- Observation without surgery: Sometimes, if the blood clot is very small and there are no symptoms, surgery is not necessary. The doctor will keep you in the hospital for observation. They will give you medications and do repeated scans to see if the blood clot dissolves.
How long will it take to heal?
The recovery time from this condition varies from person to person. Some people recover completely within a few weeks. But some people, especially those with extensive brain damage, may not recover completely.
If you continue to have memory problems or weakness after surgery, you may need rehabilitation.
- Physical therapists: Help with things like walking and maintaining balance.
- Occupational therapists: Retrain people to perform daily tasks independently (such as getting dressed, eating).
- Speech-language pathologists: Treat speech or swallowing problems.
Are there any complications of this condition?
If left untreated, large blood clots can lead to coma and even death. In addition, complications such as these can occur.
- Brain herniation: This is a condition where pressure in the brain increases so much that parts of the brain bulge out of their normal position. This is very dangerous.
- Rebleeding: There is a risk of rebleeding after surgery, especially in the elderly.
- Seizures: Some people may experience seizures even after treatment and recovery.
Take-Home Message
- When you hit your head, don't just think, "It's nothing serious." Especially if you're an elderly person, a small child, or someone taking blood-thinning medication, be sure to see a doctor.
- If you have symptoms such as persistent headache, vomiting, difficulty speaking, weakness on one side of the body, or confusion, do not waste time and go to a hospital's Emergency Department (ETU) immediately.
- The longer you delay seeking treatment, the more damage your brain can do. So seeking medical advice quickly could help save your life or the life of a loved one.
- Follow the doctor's instructions exactly. Be careful not to hit your head while you are recovering.
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