Subdural hemorrhages are serious conditions that may be life-threatening if not identified and managed quickly. Being aware of the key signs and symptoms of this condition is key to early diagnosis and treatment.

In this article, you will learn:

• What is a subdural hemorrhage and its causes
• The early signs and symptoms of the condition
• Who is most at risk of developing a subdural hemorrhage
• The mortality rate of this condition
• How subdural hemorrhage is diagnosed and treated

What is a subdural hemorrhage?

A subdural hemorrhage, also known as a subdural hematoma, is a type of intracranial hemorrhage. It occurs when blood collects between the skull and the meninges, which are the three protective layers of tissue that surround the brain. 

The outermost layer of the meninges is made out of tough, fibrous tissue and is known as the dura mater. The innermost layer is the pia and the middle layer is the arachnoid. Cerebrospinal fluid (CSF) helps to cushion and further protect these layers.

In a subdural hemorrhage, bleeding occurs between the dura mater and arachnoid layers of the meninges due to injury of one of the blood vessels. As blood pools in the area, it causes increased pressure inside the skull and can eventually lead to brain damage or death.

Any injury that causes a sudden impact and damages the blood vessels that supply the dura mater can result in a bleed. Most commonly, subdural hemorrhage is caused by injury or trauma to the head. 

What are the symptoms associated with subdural hemorrhages?

Symptoms of subdural hemorrhages are caused by increases in intracranial pressure, which makes it harder for the brain to function optimally.

Thus, the symptoms may be mild at first and get worse over time as more blood pools between the brain and the skull.

Common symptoms of subdural hemorrhage include:

• Breathing problems
• Confusion
• Dizziness
• Drowsiness
• Loss of balance
• Loss of stability when walking
• Muscle weakness
• Nausea and vomiting
• Paralysis
• Seizures
• Severe headaches
• Vision changes
• Unconsciousness

Who is most Likely to be affected by a subdural hemorrhage?

Anybody can suffer from a subdural hemorrhage if they have experienced a traumatic injury.

However, there are certain risk factors that may increase the risk of a subdural hemorrhage, including:

• Age-associated shrinkage (atrophy) of the brain tissue
• Head injury, caused by accidents or violence
• Playing high-impact sports
• Certain medications that thin the blood (known as anticoagulants), such as warfarin and aspirin
• Alcohol abuse

While the mortality rate of subdural hemorrhage ranges from 36% to 79%, even those who survive rarely regain their previous level of cognitive and physical functioning. The prognosis depends on the severity of the bleed and the extent of treatment that was received by the patient.

How are subdural hemorrhages diagnosed?

If you or somebody you know has recently had a severe head injury, it’s essential that you go to nearest hospital for a full medical assessment.

Why?

There may be an underlying head injury that is not obvious at first!

Medical professionals may use a range of diagnostic tools to identify a subdural hemorrhage. This includes physical and neurological examinations, and even diagnostic radiologic imaging.

During the physical and neurological examination, doctors will check your reflexes and look out for any signs of muscle weakness or paralysis. They will measure the vital signs and the levels of consciousness.

Computed tomography (CT) or magnetic resonance imaging (MRI) scans of the brain are used to diagnose the presence, identify the location and severity of the bleed.

Blood tests may be necessary to identify or rule out potential bleeding disorders by measuring the levels of blood clotting factors.

How are subdural hemorrhages treated?

The number one priority when somebody has suffered from a subdural hemorrhage is relieving pressure on the brain. This can be through a variety of different methods, most commonly surgical methods.

Doctors may cut a flap of the skull open to drain the blood out of the area in a procedure known as a craniotomy. They may also drill a hole into the skull to drain the blood and this is known as a burr hole.

For smaller hematomas, surgery may not be required. It may heal on its own or only require minimally invasive interventions.

Doctors can use alternative methods to monitor the bleed and ensure it doesn’t get any worse. Some of these alternative methods include:

• Placing a sensor inside the skull to measure the intracranial pressure
• Monitor the bleed through CT scans
• Administer medications to reverse the effects of the anticoagulant medications

In some cases, bleeding around the brain may continue despite medical and surgical treatment. Minimally-invasive procedures can be performed to block off an artery supplying the area that is bleeding!

Interventional radiologists are able to place a small catheter into the middle meningeal artery, which supplies the area of bleeding. Under live X-ray guidance, small particles are carefully injected to reduce blood flow in the artery and stop the bleeding.

What is the recovery process like?

Depending on the severity of the subdural hemorrhage, the recovery process can take several weeks to months. There is always a risk of another bleed occurring again in the future because the blood vessels are now damaged.

After the subdural hemorrhage has fully healed and the patient has recovered from their treatments, they will need to avoid high-risk activities for the foreseeable future. This includes cutting out any high-impact sports, working on improving balance to prevent falls, and driving carefully to reduce the risk of car accidents.

Doctors may also insist that patients return to the hospital for regular CT scans in the months following treatment. Sometimes, repeat surgeries are required to drain more blood from the skull.

As part of the recovery process, patients may work with physiotherapists and occupational therapists to regain as much of their normal functioning as possible and to find ways to make life easier and more comfortable. Speech and language therapy might be necessary if speech has been affected by the subdural hemorrhage.

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References

[1] https://my.clevelandclinic.org/health/diseases/21183-subdural-hematoma 

[2] https://www.medscape.com/answers/1137207-32003/what-is-the-prognosis-of-subdural-hematoma-sdh

[3] https://www.nhs.uk/conditions/subdural-haematoma/recovery/