Subdural Hematoma

Overview

A subdural hematoma is a collection of blood that forms between the brain’s surface and its outer protective covering, called the dura. It usually happens when small blood vessels are torn, often after a head injury. As blood collects, it can put pressure on the brain and affect how the brain works.

Subdural hematomas can develop quickly or slowly. An acute subdural hematoma appears soon after an injury and can be life-threatening. A chronic subdural hematoma may develop over days or weeks, sometimes after a mild bump to the head that may not seem serious at the time. Both types require medical evaluation, because symptoms can change or worsen.

This condition is managed by specialists such as neurologists, neurosurgeons, emergency physicians, and intensive care teams, depending on its severity. With timely assessment and appropriate care, many patients can be treated effectively, but the outcome depends on factors such as the size of the bleeding, the patient’s age, overall health, and how quickly treatment begins.

Symptoms

Symptoms of a subdural hematoma vary widely. Some people have obvious symptoms soon after a head injury, while others develop gradual changes over time. Symptoms may include:

• Headache that is new, severe, or worsening
• Confusion, unusual sleepiness, or difficulty staying awake
• Nausea or vomiting
• Dizziness or balance problems
• Weakness or numbness on one side of the body
• Slurred speech or difficulty speaking
• Vision changes
• Memory problems or personality changes
• Seizures
• Loss of consciousness

In older adults, a chronic subdural hematoma may appear as increasing forgetfulness, reduced alertness, unsteady walking, or behavior changes. These symptoms can resemble other neurological conditions, which is why medical assessment and imaging are important.

Causes and Risk Factors

The most common cause of a subdural hematoma is head trauma. This may occur after a fall, traffic accident, sports injury, or a blow to the head. In some cases, the injury may be minor, especially in older adults, but bleeding can still develop.

Certain factors can increase the risk of a subdural hematoma or make bleeding more likely after an injury. These include:

• Older age, as the brain may shrink slightly with age, stretching the veins around it
• Falls or frequent balance problems
• Use of blood-thinning medicines or conditions that affect blood clotting
• Heavy alcohol use, which can increase fall risk and affect clotting
• Previous brain injury or brain surgery
• Medical conditions that increase bleeding tendency

Infants and young children can also develop subdural hematomas after significant head injury. Any concern about head trauma in a child should be assessed promptly by a healthcare professional.

Diagnosis

Diagnosis begins with a medical history and physical examination. The healthcare team may ask about a recent fall or injury, current symptoms, medical conditions, and medicines that may affect bleeding. A neurological examination may check alertness, speech, strength, sensation, coordination, reflexes, and pupils.

Imaging tests are essential to confirm a subdural hematoma and understand its size and effect on the brain. A computed tomography scan is commonly used in urgent situations because it can quickly show bleeding. Magnetic resonance imaging may be used in selected cases, especially when symptoms develop slowly or when more detail is needed.

Blood tests may be performed to assess clotting ability, blood counts, and other health factors that may influence treatment planning. In emergency cases, diagnosis and treatment decisions may happen quickly to reduce the risk of brain pressure and further neurological damage.

Treatment Options

Treatment depends on the size of the hematoma, the amount of pressure on the brain, the patient’s symptoms, overall health, and whether the bleeding is acute or chronic. Some small subdural hematomas with mild or no symptoms may be monitored closely in the hospital or through follow-up imaging, as advised by the medical team.

If the hematoma is large, causing significant pressure, or symptoms are worsening, a neurosurgical procedure may be needed to remove the collected blood and reduce pressure on the brain. The type of procedure depends on the situation and may range from creating a small opening to drain the blood to a larger operation when necessary.

Supportive care may include monitoring in a specialized unit, repeated neurological checks, imaging follow-up, and management of factors that increase bleeding risk. Rehabilitation may be recommended if the patient has weakness, speech difficulty, balance problems, or cognitive changes after the hematoma. Rehabilitation can involve physical therapy, occupational therapy, speech therapy, and ongoing neurological care.

Because every case is different, the care plan should be individualized by the treating medical team. Patients should not stop or change prescribed medicines without medical guidance, especially medicines that affect blood clotting.

When to See a Doctor

Seek urgent medical care after a head injury if there is loss of consciousness, worsening headache, repeated vomiting, confusion, severe drowsiness, seizure, weakness, numbness, slurred speech, vision changes, or difficulty walking. These symptoms may indicate bleeding or pressure inside the skull.

Older adults, people taking medicines that affect blood clotting, and people with bleeding disorders should be evaluated after a significant fall or head injury, even if symptoms seem mild at first. Symptoms of a chronic subdural hematoma can develop gradually, so new confusion, memory problems, personality changes, or balance issues after a head injury should not be ignored.

A subdural hematoma can be serious, but early evaluation helps doctors identify the problem and choose appropriate treatment. If symptoms are sudden or severe, emergency medical services should be contacted immediately.