What Is a Subdural Hemorrhage?

A subdural hemorrhage, also called a subdural hematoma, is a kind of intracranial hemorrhage, which is the bleeding in the area between the brain and the skull. Specifically, it is a bleed just under the dura, which is one of the protective layers of tissue that surrounds the brain. Bleeding in this location can create pressure on your brain, which can impair function and even be life-threatening if it isn’t treated.

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Types of Subdural Hemorrhage

A subdural hemorrhage can be acute, subacute, or chronic.

• Acute Subdural Hemorrhage
  This is a subdural hemorrhage that happens quickly. It is caused by a traumatic head injury, such as a blow to the head or a fall. In an acute subdural hemorrhage, symptoms appear within minutes or hours after the injury. This indicates that there is significant bleeding inside the skull, and pressure against the brain is building rapidly. An acute subdural hemorrhage is a medical emergency that requires immediate treatment.
• Subacute Subdural Hemorrhage
  A subacute subdural hemorrhage is also a serious condition, but it’s not as emergent as an acute hemorrhage. In a subacute injury, the symptoms appear more slowly, possibly days or weeks after the head injury. This means that the bleeding is slower and the pressure against the brain is taking more time to build. Even though a subacute hemorrhage is less dangerous, it can also be life-threatening if it’s not treated.
• Chronic Subdural Hemorrhage
  A chronic subdural hemorrhage takes even longer to show symptoms. It may be weeks or months after a head injury before a chronic hemorrhage causes any symptoms.

Causes of Subdural Hemorrhage

Subdural hemorrhages are usually caused by a head injury. If you bump your head in a fall or an accident, it’s important to be assessed by a medical professional. Activities that are highly likely to cause a serious head injury include high-impact sports and car crashes.

Learn more about assessment, prevention, and treatment of sports concussions

Certain groups of people are at higher risk of subdural hemorrhage:

• For babies younger than four months; rough shaking could cause brain injury
• In older adults; with age brain shrinks, causing fragility
• People who take certain medications such as blood thinners
• Alcohol abusers
• People who play high-impact sports such as football

Symptoms of Subdural Hemorrhage

The symptoms of subdural hemorrhage are related to the increased pressure on the brain. The pressure makes it more difficult for the neurons in the brain to transmit information. The symptoms of a brain bleed are similar to a stroke since the pressure on the brain can reduce or cut off the flow of blood to that area of the brain.
These symptoms include:

• Headache
• Vomiting
• Difficulty walking
• Difficulty balancing
• Vision changes
• Muscle weakness
• Numbness or paralysis
• Confusion
• Drowsiness
• Slurred speech
• Unconsciousness

If left untreated, a subdural hemorrhage can lead to paralysis, decreased breathing, and death.

Diagnosis

If you or someone you know has any symptoms following a head injury, it is important to get assessed by a medical professional as soon as possible.

Diagnosis includes:

• Physical and Neurological Exam
  A doctor will assess the patients’ vital signs, level of consciousness (GCS) and a thorough neurological examination, to test brain function.
• Imaging
  • Computed tomography (CT)
  • Magnetic resonance imaging (MRI) brain may rarely be necessary.

Subdural Hemorrhage Treatment

If the subdural hemorrhage is small and subacute, doctors may recommend waiting to see if it heals on its own.

If a subdural hemorrhage is large or bleeding quickly, it is treated with surgery. A surgeon will remove a part of your skull and drain the blood to relieve pressure on the brain.

After a subdural hemorrhage has fully healed, patients still need to be cautious and avoid high-risk activities. After a traumatic brain injury, they are at high risk for another hematoma. It can take a year or more for the brain to recover from the effects of the injury, and a second head injury during that time could cause long-term changes in function.

Prevention

The best way to prevent subdural hemorrhage is by avoiding head injury. You can do this by minimizing high-risk activities, wearing appropriate head protection during all high-impact sports, and always wearing a seatbelt while in a motor vehicle.

A subdural hemorrhage is an emergency that requires immediate treatment. Our team of board-certified neurosurgeons can treat subdural hemorrhage and other types of brain injury. If you’ve experienced a head injury with concussion or bleeding, our Department of Neurosurgery can assess your condition and treat both chronic and emergent hemorrhage.

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