Subdural Haematoma
What is Subdural Haematoma
This is accumulation of blood on the brain surface just beneath the covering membrane of the brain called dura mater.
Types of SDH
Acute SDH
When the blood accumulates immediately after injury in the head or accumulates rapidly due to some other cause , the condition is called acute SDH.
Chronic SDH
When blood accumulates slowly over a period of few days or weeks after head injury or accumulates slowly due to some other cause.
Causes of SDH
Acute SDH
- Usually seen after head injury which may result from road accidents or fall from height or head hit by some object.
- This result from shearing forces which tear the blood vessels over the surface of brain and this may be associated with injury to the underlying brain structure also.
- Acute SDH may occur spontaneously without any trauma. This collection of blood may result from some vascular malformaton over the surface of brain or anomalies in the brain covering membranes.
Chronic SDH
- More commonly seen in elderly people and usually seen after trivial or minor trauma to head which may go unnoticed and manifest after few days or weeks.
- This may occur spontaneously in patients receiving anticoagulant therapy or blood thinners for heart problem.
- Bleeding diathesis or blood disorders may result in formation of chronic SDH.
- Tumours (metastasis) of brain covering membrane (dura mater) may be the cause of SDH in some cases.
Signs and Symptoms
Acute SDH- Depending on the area of the brain affected by SDH and on the severity of injury, patient may present with
- Confusion
- Irritability
- Altered sensorium
- Weakness of arm or leg
- Incoherent speech
- Unconsciousness
Chronic SDH-presentation of symptoms is very subtle and usually in elderly population. Patient presents with
- Forgetfulness,
- Headache with or without vomiting,
- Behavioural changes,
- Weakness on one side of body.
Intensity of symptoms may be waxing and waning. In advanced cases, patient presents with
- slurring of speech,
- paralysis on one side of body
- loss of consciousness.
Diagnosis
SDH is usually diagnosed with the help of CT scan or MRI scan.
These investigations not only diagnose the condition but also helps planning the treatment modalities like medicinal treatment or surgical treatment.
Treatment
Two modes of treatment,
- Medicinal treatment
- Surgical treatment
Medical Management, if the amount of blood in the subdural space is less and it is not causing any pressure effect over the brain.
Surgery is required if the amount of blood is sufficient enough to cause pressure effect over the brain.
Surgery if required should be done early to prevent the patient from going into deep coma or unconsciousness and in most of such cases, surgery is life saving.