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Subdural haematomas are potentially serious conditions that usually occur as a result of a head injury, and can result in serious long-term health consequences.
The effects of a subdural haematoma can take some time to emerge, but once they have been detected, urgent treatment is essential to prevent the individual from being left with life-altering disabilities.
What is a subdural haematoma, and what causes them?
Also known as a brain haematoma, this condition occurs when a blood vessel in the space between the skull and the brain - the subdural space - is damaged.
This causes blood to escape from the vessel, leading to the formation of a blood clot or haematoma that places pressure on the brain and damages it. Because the skull is a rigid structure that cannot expand, the haematoma pushes down on the brain as it develops, and the pressure inside the skull increases.
The initial bleed can develop soon after a severe head injury - a condition known as an acute subdural haematoma - but very occasionally, it can emerge a few days or weeks after a more minor head injury, known as a subacute or chronic subdural haematoma. The symptoms are sometimes missed and brain damage can occur because of the delay in diagnosis and treatment.
What are the symptoms of a subdural haematoma?
Symptoms of a subdural haematoma are linked to the raised intracranial pressure and can include:
- a headache that keeps getting worse
- feeling and being sick
- personality changes, such as being unusually aggressive or having rapid mood swings
- feeling drowsy
Who is at risk from subdural haematomas?
Generally, subdural haematomas are experienced as a direct consequence of severe head injuries, such as those sustained in a car crash, fall or violent assault.
However, minor bumps to the head can also lead to subdural haematomas in a few cases. This is more likely to occur among individuals who are over 60 years of age, taking blood-thinning medication such as warfarin, or who have a history of alcohol misuse.
How are subdural haematomas treated?
Subdural haematomas usually need to be treated with surgery as soon as possible in order to relieve the pressure on the brain. The two most widely used surgical techniques are:
- craniotomy - a section of the skull is temporarily removed so the surgeon can access and remove the haematoma
- burr holes - a small hole is drilled into the skull and a tube is inserted through the hole to help drain the haematoma
In a few cases, very small subdural haematomas may be carefully monitored first to see if they are able to heal without the need for an operation.
What are the long-term effects of subdural haematomas?
The long-term effects depend upon how quickly the subdural haematoma is diagnosed and treated. If the pressure is relieved within a reasonable time frame, the brain is less damaged. However, subdural haematoma is generally seen as a serious condition that carries a high risk of injury and death, particularly in older people and those who have sustained severe brain damage.
Acute subdural haematomas are the most dangerous type, because they are frequently associated with significant damage to the brain. Those who survive an acute subdural haematoma may take a long time to recover and may be left with physical and mental disabilities as a result, but the injury may be avoidable if treatment had occurred earlier.
How can subdural haematoma patients find out more?
If you are looking for additional information and support on subdural haematoma, there are a number of organisations and resources that may be useful to you:
- Child Brain Injury Trust
- United Kingdom Acquired Brain Injury Forum (UKABIF)
- The Brain Charity
- NHS information on subdural haematoma
If you are concerned that a delay in diagnosing and treating a subdural haematoma has resulted in injury or death for a loved one, we can investigate the circumstances by reviewing the medical records and obtaining independent expert evidence from experts in neuroradiology, neuro-surgery and neurology.