What is a subdural hematoma? — A subdural hematoma is bleeding on the surface of the brain. The bleeding occurs under the tough, outer covering of the brain, called the "dura" (figure 1). Although the bleeding is not actually in the brain, if there is a big blood clot, it can put pressure on the brain. This can lead to symptoms.
An injury to the head causes most subdural hematomas. The most common causes of these injuries include:
A car crash
A physical attack
There are 2 main types of subdural hematomas:
Acute – This type happens in the first hours after a head injury. If the bleeding continues, the subdural hematoma can keep growing, days after the injury.
Chronic – This type happens most often in older people whose brains have shrunk slightly due to age. In these people, a mild head injury can cause a tear in a small vein. This can then lead to bleeding on the brain's surface. The injury can be so mild that the person doesn't even notice it or remember it later. The hematoma grows slowly, over several days or weeks.
What are the symptoms of subdural hematoma? — Some people pass out after getting a serious head injury and a large, acute subdural hematoma. Other times, the symptoms appear later and can include:
Slurred speech or being unable to speak
Acting less alert than normal
Confusion or trouble thinking
Will I need tests? — Yes. Tests include imaging tests that take pictures of your brain, such as an MRI or CT scan. These will show the subdural hematoma and where and how big it is.
How is subdural hematoma treated? — The treatment depends on the size of the hematoma and your symptoms. You might need surgery to drain the hematoma and relieve the pressure on your brain. If the hematoma is small, your doctor might recommend waiting to see if it gets better on its own. In this case, he or she might do a follow-up MRI or CT scan to confirm that the hematoma is going away.
If you are taking medicines known as "blood-thinners," such as aspirin or warfarin (sample brand names: Coumadin, Jantoven), your doctor might tell you to stop taking these medicines. Be sure to talk to the doctor who first prescribed these medicines about when and if you should take them again.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 17230 Version 6.0
Release: 28.2.2 - C28.105
© 2020 UpToDate, Inc. and/or its affiliates. All rights reserved.