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Causes of Acute Subdural Hematoma

Acute hematomas usually occur when a head injury suddenly jolts or shakes the brain, causing the small veins that connect the brain to the dura (outer protective covering of the brain) to rupture and leak blood. They are almost always the result of blunt head trauma, such as that caused by violence, motor vehicle accidents, or severe falls. Acute subdural hematomas are reported in 10- 20 percent of all traumatic brain injury cases and occur in up to 30 percent of fatal injuries.

Signs and Symptoms of Acute Subdural Hematoma

Signs and symptoms of an acute subdural hematoma largely depend on the area of the brain affected by the blood and the size of the hematoma.

• Loss of consciousness. Because acute subdural hematoma usually occurs after severe head trauma, often patients experience an initial temporary lost of consciousness at the time of the injury. Others remain conscious, but deteriorate in a delayed fashion as the hematoma develops slowly over the next several minutes or hours. Then the patient may lose consciousness again, due to the bleeding. This phenomenon is widely known as a lucid interval or lucid period and quite common in traumatic, acute subdural and epidural hematomas.
• Dilation of the pupil. As the hematoma gets larger, the pupil of one eye will dilate, or become wider. The eye on the side of the head with the injury is the eye affected (for instance, if the left hemisphere of the brain is affected, the left-eye dilates, vice versa). This dilation happens almost at the same time as increasing body weakness. The weakness is usually on the side of the body opposite the hematoma.
• Other symptoms may include:
  • Severe headache
  • Nausea
  • Vomiting
    
  • Seizures
  • Visual dysfunction
    

Treatment of acute subdural hematoma

• Craniotomy. Acute subdural hematomas with a thickness greater than 10 mm or a midline shift (MLS) greater than 5 mm on computed tomographic (CT) scan and a Glasgow Coma Scale (GCS) of 9 or lower are typically removed surgically with a procedure called a craniotomy, in which the surgeon accesses the brain through an opening created in the skull and then removes or evacuates the hematoma with suction, irrigation, and a tool called cup forceps. Cerebral contusions (scattered areas of bleeding on the surface of the brain) underlying the subdural hematoma are often removed at the same surgery. The bleeding vein is clotted if it is still bleeding. Craniotomy is a major surgical procedure and is performed under general anesthesia. The death rate following even the best brain surgery has been reported to be as high as 80%.
• Non-operative treatment. Smaller subdural hematomas may not require surgery as long as the patients are neurologically stable after the injury and do not have pupillary abnormalities and intracranial hypertension.

Post-treatment Recovery

Recovery from acute subdural hematoma after treatment varies widely. Around 20 to 30 percent of patients will recover full or partial brain function. They may have changes in consciousness level, motor skills, and activities of daily living. Many individuals have problems with memory, judgment, and attention span. Some of these changes may be permanent. Postoperative seizures are also quite common, requiring medicines for control.

These patients with impaired brain function are at risk for future injuries. Psychological counseling may be helpful for both the individual and the family. Any new or worsening symptoms should be reported to the healthcare provider.