If you have a subdural hematoma, blood is leaking out of a torn vessel into a space below the dura mater, a membrane between the brain and the skull. Symptoms include ongoing headache, confusion and drowsiness, nausea and vomiting, slurred speech and changes in vision. Subdural hematomas can be serious. See your healthcare provider if you have a head injury.
A subdural hematoma is a type of bleed inside your head. It's a type of bleed that occurs within your skull but outside the actual brain tissue. The brain has three membrane layers or coverings (called meninges) that lie between the bony skull and your brain tissue. The purpose of the meninges is to cover and protect the brain.
If you have a subdural hematoma, you have experienced a tear in a blood vessel, most commonly a vein, and blood is leaking out of the torn vessel into the space below the dura mater membrane layer. This space is called the subdural space because it is below the dura. Bleeding into this space is called a subdural hemorrhage.
Other names for subdural hematoma are subdural hemorrhage or intracranial hematoma. More broadly, it is also a type of traumatic brain injury (TBI).
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Subdural hematomas occur in up to 25% of people with head injuries.
Yes, a subdural hematoma can be a serious event. Occasionally, the bleed is slow and the body is able to absorb the pooled blood. However, if the hematoma is severe, the buildup of blood can cause pressure on the brain. This pressure can lead to breathing problems, paralysis and death if not treated.
Because you don’t immediately know how severe a brain bleed is until further testing, all blows to the head should be considered a serious event. If you hit your head, get checked out at a hospital.
Yes. Doctors sort subdural hematomas by how fast they develop, how much bleeding occurs, and how much damage the bleeding causes. The types of subdural hematoma are:
Although anyone can get a subdural hematoma from an accidental head injury, certain groups of people are at higher risk. Subdural hematomas are more common in:
Head injuries cause most subdural hematomas. If you fall and hit your head or take a blow to the head in a car or bike accident, a sporting activity or have another type of head trauma, you are at risk for developing a subdural hematoma.
Because a subdural hematoma is a type of traumatic brain injury (TBI), they share many symptoms. Symptoms of a subdural hematoma may appear immediately following trauma to the head, or they may develop over time – even weeks to months.
Signs and symptoms of a subdural hematoma include:
As bleeding continues and the pressure in the brain increases, symptoms can get worse. Symptoms, at this point, include:
Sometimes people have no symptoms immediately following a head injury. This is called a lucid interval. They develop symptoms days later. Also, it’s important to know that subdural hematomas that develop more slowly (the chronic type) might be mistaken for other conditions, such as a brain tumor or stroke.
Special note about head injury and symptoms in seniors: Some of the symptoms of subdural hematoma in older people, like memory loss, confusion, and personality changes, could be mistaken for dementia. The older person may not remember hitting their head. Sometimes, people forget because they are disoriented. Other times, the injury was minor and may have occurred weeks before symptoms appeared. They should still see their healthcare provider for evaluation.
First, your healthcare provider will do a thorough physical and neurological exam. Your healthcare provider will ask you about your head injury (when and how it occurred, review your symptoms and other medical problems, review medications you are taking and ask about other lifestyle habits). The neurology exam will include blood pressure checks, vision testing, balance and strength testing, as well as reflex tests and a memory check.
If your healthcare provider thinks you may have a subdural hematoma, they will order a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of your head. These imaging tests allow healthcare providers to see clear pictures of the brain and determine the location and amount of bleeding or other head and neck injuries.
Healthcare providers treat larger hematomas with decompression surgery. A surgeon drills one or more holes in the skull to drain the blood. Draining the blood relieves the pressure the blood buildup causes on the brain. Additional surgery may be needed to remove large or thick blood clots if present. Usually, healthcare providers leave a drain in place for several days following surgery to allow the blood to continue draining.
Sometimes hematomas cause few or no symptoms and are small enough that they don’t require surgical treatment. Bed rest, medications and observation may be all that is needed. The body can absorb the small amount of blood over time, usually a few months. Your healthcare providers may order regular imaging tests (such as an MRI) to monitor the hematoma and make sure it is healing.
Side effects from decompression surgery include an increased risk of bleeding, infection and blood clots. Your healthcare providers will monitor you closely after surgery.
Without treatment, large hematomas can lead to coma and death. Other complications include:
Although it may not be possible to prevent a hematoma as a result of an accident, you can reduce your risk by:
If you have a subdural hematoma, your prognosis depends on your age, the severity of your head injury and how quickly you received treatment. About 50% of people with large acute hematomas survive, though permanent brain damage often occurs as a result of the injury. Younger people have a higher chance of survival than older adults.
People with chronic subdural hematomas usually have the best prognosis, especially if they have few or no symptoms and remained awake and alert after the head injury.
Older adults have an increased risk of developing another bleed (hemorrhage) after recovering from a chronic subdural hematoma. This is because older brains cannot re-expand and fill the space where the blood was, leaving them more vulnerable to future brain bleeds with even minor head injuries.
A subdural hematoma is always a risk after a head injury. If you or someone you know has any of the following symptoms after a head injury, call 911 or seek medical attention immediately.
People at increased risk of a subdural hematoma – even though the head injury appears minor – should also get immediate medical attention. These people include:
Subdural hematomas can be life-threatening. If you have a head injury, get immediate medical attention. Don’t wait to “see if symptoms develop.” It’s better to be safe, than sorry.
Last reviewed by a Cleveland Clinic medical professional on 05/04/2020.
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