Subdural Hematoma

GENERAL INFORMATION:

What is a subdural hematoma? Subdural hematoma (SDH) is a condition when blood collects underneath the protective covering of the brain known as the dura. The dura is the outermost and strongest of the three protective layers of the brain. With subdural hematoma, veins (blood vessels) that are in the dura may tear and bleed. Blood collects within the dura, causing the dura to expand, push, and compress the brain. This compression (squeezing) of the brain can lead to serious medical problems.

What causes subdural hematoma? Subdural hematoma may be caused by any of the following:

• A serious head injury. This causes an acute (sudden) subdural hematoma.
  
  
• Medicines that make the veins more likely to bleed, such as clot busters and blood thinners.
  
  
• Aging causes the brain to shrink. When the brain shrinks, it pulls on the dura, stretching the veins, making them more likely to bleed. In the elderly, symptoms may take several weeks to appear. This is called chronic (long-term) subdural hematoma.
  
  
• Medical conditions such as cancer, liver disease due to alcohol abuse, and blood vessel wall weakness.

What are the signs and symptoms of subdural hematoma?

• Body weakness that may happen quickly or slowly over time.
  
  
• Decreased level of alertness.
  
  
• Difficulty speaking or slurred speech.
  
  
• Fainting or loss of consciousness (passing out).
  
  
• Feeling nauseated (sick to the stomach) and vomiting (throwing up).
  
  
• Headache.
  
  
• Neck stiffness.
  
  
• Seizures (convulsions).

How is subdural hematoma diagnosed?

• CT scan:
  
  
  • This is also called a CAT scan. A special x-ray machine uses a computer to take pictures of your brain. It may be used to look at bones, muscles, brain tissue, and blood vessels.
    
    
  • You may be given dye before the pictures are taken. The dye is usually given in your IV. The dye may help your caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish, or have other allergies or medical conditions.
  
  
• MRI: This test is called magnetic resonance imaging. During the MRI, pictures are taken of your head. An MRI may be used to look at the brain, muscles, joints, bones, or blood vessels. You will need to lay still during a MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury. Tell your caregiver if you have any metal implants in your body.

How is subdural hematoma treated? You may have one or more of the following treatments:

• Surgery: This is the only treatment that can remove the blood in the dura. Ask your caregiver for more information about surgery used to treat subdural hematoma.
  
  
• Medicines: If surgery cannot be done, you may receive the following medicines:
  
  
  • Diuretics: You may get diuretic medicine to help decrease swelling in your brain. This may help your brain get better blood flow.
    
    
  • Steroids: Steroid medicine may be given to decrease inflammation, which is redness, pain, and swelling.
    
    
  • Anticonvulsant medicine: Anticonvulsants are given to control seizures.
  
  
• Bed rest: You may need to rest in bed if you have a small amount of blood in the dura. Caregivers may want to see you often to be sure there is no further bleeding.

Where can I find support and more information? Having a subdural hematoma is a life-changing condition for you and your family. Accepting that you have a subdural hematoma is hard. You and those close to you may feel sad, anxious, and frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. You may also want to join a support group with other people who have had a subdural hematoma. Contact the following for more information:

• Brain Injury Association
  8201 Greensboro Drive
  McLean, VA 22102
  Phone: 1-703-761-0750
  Phone: 1-800-444-6443
  Web Address: http://www.biausa.org
  

• National Headache Foundation
  820 N. Orleans, Suite 217
  Chicago, IL 60610
  Phone: 1-888-NHF-5552
  Web Address: http://www.headaches.org
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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