(Extra-axial Haematoma; Subdural Haemorrhage; SDH)
Pronounced: sub-dur-al hee-ma-toe-ma
A subdural hematoma (SDH) is a collection of blood that clots in the subdural region of the brain. This region is a space between the skull and the outside of the head. The pooling of blood puts pressure on the brain. SDH can be classified by the time between the trauma and symptoms:
- Acute—less than 48 hours
- Subacute—2-12 days
- Chronic—more than 12 days
This can be serious and life-threatening. It requires care from your doctor.
SDH is most often caused by:
- Head injury due to trauma]]> (eg, from falls or car accidents)
The following factors increase your chance of developing a SDH:
- Being of advanced age (due to greater risk of falls and weaker blood vessels)
- Playing high-impact sports
- Taking blood thinning medication
- Having atrial fibrillation]]>
- Having a history of ]]>heart attack]]>
- ]]>Abusing alcohol]]> or ]]>drugs]]>
- Being physically abused
If you have any of these risk factors, tell your doctor.
If you have any of these symptoms, do not assume it is due to SDH. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:
- Loss of consciousness
- Bruising around the head or eyes
- Nausea or vomiting
- Personality changes
- Limb weakness
- Speech difficulties
- Visual impairment
Your doctor will ask about your symptoms and medical history. She will also do a physical exam. You may be referred to a neurologist for special testing.
Tests may include:
- CT scan]]>—a type of x-ray that uses a computer to make pictures of structures inside the head
- ]]>MRI scan]]>—a test that uses magnetic waves to make pictures of structures inside the head
- Blood tests
- Neurological examination
- ]]>EEG]]> (electroencephalogram)—a noninvasive test used to evaluate brain function
Talk with your doctor about the best treatment plan for you. Treatment will depend on:
- Size and severity of the hematoma
Treatment options include the following:
Monitoring and Observation
For minor injury with little or no symptoms, your doctor may advise that you watch for symptoms to develop in the days and weeks that follow.
You may need more testing done. These tests assess how your brain functions. The results can help your doctor determine:
- How you are recovering
- Whether you are ready to return to high-impact activities
In some cases, your doctor may prescribe antiseizure medication.
This usually involves making “burr holes” in the scalp and skull and draining the clotting blood. Sometimes a section of the skull is removed to relieve pressure. This is called a craniotomy.
To help reduce your chance of SDH, take these steps:
- Wear proper helmets when playing sports.
- Reduce the risk of fall or injury. Safeguard your home and workplace.
- Have regular blood tests if you are taking blood thinning medicine.
- Limit your alcohol intake to a moderate level. This means:
- Two or fewer drinks per day for men
- One or fewer drinks per day for women
American Academy of Neurology
American Academy of Otolaryngology, Head and Neck Surgery
Brain Injury Association of America
The Brain Injury Association of Canada
Ontario Brain Injury Association
Servadei F, Compagnone C, Sahuquillo J. The role of surgery in traumatic brain injury. Curr Opin Crit Care. 2007;13:163-168.
Subdural hematoma. EBSCO Dynamed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated April 16, 2009. Accessed May 19, 2009.
Subdural haematoma. Patient UK website. Available at: http://www.patient.co.uk/showdoc/27001513/. Updated March 2009. Accessed May 19, 2009.
Subdural haematoma. Patient UK website. Available at: http://www.patient.co.uk/showdoc/40000761. Accessed May 19, 2009.
Surgical management of acute subdural hematomas. AHRQ National Guideline Clearinghouse website. Available at: http://www.guideline.gov/summary/summary.aspx?doc_id=9440&nbr=5061&ss=6&xl=999. Updated May 2009. Accessed May 19, 2009.
Last reviewed June 2009 by ]]>Rimas Lukas, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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