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Subdural Hematoma

Haematoma Subdural

Subdural hematoma is defined as a collection of blood outside the brain below the dura mater.


Presentation

Presentations seen is dependent on the level of bleeding but general include siezures, apathy, weakness, lethargy, nausea, dizziness, behaviorual changes, confusion and severe headache

Chronic subdural hematoma may have presentation similar to what is seen with Parkinson disease. An acute presentation is equally possible as seen in patients who show seizure as a symptom.

Confusion and headache appears to be the most common presenting features as it is seen in as much as 90% to 56% of cases.

Epilepsy
  • CONCLUSIONS: In case of refractory treatment of epilepsy, dislocation of pacemaker electrodes is a, most certainly, rare but possible differential diagnosis.[ncbi.nlm.nih.gov]
  • As many as 10 percent of patients had a history of alcoholism or epilepsy, the Welsh team reported. Obesity can be a contributing factor by increasing estrogen levels in the body, Dr. Samadani said.[well.blogs.nytimes.com]
  • […] subdural hematoma include the following: Mild or severe head trauma Acute subdural hematoma following surgey Spontaneous Risk factors for chronic subdural hematoma include the following: Diabetes Thrombocytopenia Cardiovascular disorder Arachnoid cyst Epilepsy[symptoma.com]
  • Other complications: permanent neurological impairment, long term epilepsy, CSH recurrence. Search methods for identification of studies We did not limit searches by date, language or publication status.[doi.org]
  • Preparation for Surgery Phenytoin is administered to decrease the risk of developing early posttraumatic seizures (within the first 7 days after the injury). [31] Patients have an estimated risk of greater than 20% for developing posttraumatic epilepsy[emedicine.medscape.com]
Fatigue
  • Classic symptoms of a chronic subdural hematoma include recurring headaches, personality changes, fatigue and dementia. Dementia in a subdural hematoma can be sometimes mistakenly confused with incipient Alzheimer's disease.[health-tutor.com]
  • Vomiting, numbness, and fatigue are also key manifestations. 7.[thrombocyte.com]
  • Clinical presentation varies from general and mild symptoms (e.g. headache, fatigue) to severe symptoms (e.g. hemiparesis, coma).[intechopen.com]
  • […] chronic pain requiring analgesic palliation can negatively impact sexual function, sleep hygiene, and mental alertness. 22 Reduced capacity to perform complex cognitive tasks may be attributable to the direct distraction of pain or related to associated fatigue[dx.doi.org]
Amyloidosis
  • Advanced age, hypertension, amyloidosis, high perfusion triggered by rapid hematoma release, cerebrospinal fluid (CSF) loss, oral anticoagulant, primary disease aggravation were the main mechanisms which were speculated in our report.[ncbi.nlm.nih.gov]
Nausea
  • Although headache and nausea are common side effects of vardenafil, hemorrhagic diseases should also be considered when symptoms are severe or prolonged.[ncbi.nlm.nih.gov]
Vomiting
  • A 28-year-old healthy man was admitted to our hospital because of right-sided headache, vomiting, and lower back pain after the administration of vardenafil.[ncbi.nlm.nih.gov]
  • Depending on the size of the hematoma and where it presses on the brain, any of the following symptoms may occur: Confused or slurred speech Problems with balance or walking Headache Lack of energy or confusion Seizures or loss of consciousness Nausea and vomiting[nlm.nih.gov]
Hypertension
  • Abstract BACKGROUND: Cerebral atrium diverticula are focal enlargements of the ventricular system that may develop in the presence of persistent intracranial hypertension, but they are rarely described in cases of acute intracranial hypertension.[ncbi.nlm.nih.gov]
Lower Leg Pain
  • A 71-year-old man was admitted to our hospital with 2 weeks' history of bilateral lower leg pain, dysesthesia, paraparesis, and urinary disturbance.[ncbi.nlm.nih.gov]
Diplopia
  • A 40-year-old woman with aplastic anemia visited our hospital because of severe headache, nausea, vomiting, blurred vision and diplopia for a period of 1 month. She had taken oxymetholone for 2 years.[ncbi.nlm.nih.gov]
  • The symptoms gradually worsened, and on the day of presentation to an outside hospital emergency department, the patient complained of nausea, vomiting, and diplopia.[ajnr.org]
  • 11] In a study of 14 children with intracranial injuries due to spring- or gas-powered BB or pellet guns, 10 of the children required surgery, and 6 were left with permanent neurologic injuries, including epilepsy, cognitive deficits, hydrocephalus, diplopia[emedicine.medscape.com]
  • Ocular motility disorders, including diplopia, may be related to cranial nerve dysfunction or secondary to disruption of central pathways. Vestibular injury is common in head trauma and will be discussed further.[dx.doi.org]
Pupillary Abnormality
  • Other poor prognostic indicators for acute SDH have been reported to include the initial and postresuscitation Glasgow coma scale (GCS) score, the GCS motor score on admission, pupillary abnormalities, alcohol use, injury by motorcycle, ischemic damage[emedicine.medscape.com]
  • Most patients (65-80%) present with a severely depressed conscious state, and pupillary abnormalities are seen in 40% (range 30-50%) of cases 5.[radiopaedia.org]
Anisocoria
  • The period from losing consciousness to brain herniation presenting as anisocoria was very short-only 30 minutes in our patient.[ncbi.nlm.nih.gov]
  • There are often signs of brainstem compression: miosis, mydriasis, nystagmus, anisocoria, flaccid or hypertonic limbs, and eye deviation.[ahcmedia.com]
Hemianopsia
  • Common neurological signs include aphasia, cranial nerve palsies, hemiparesis, hemisensory deficits, gait disturbances, and hemianopsia. 19,25,28,62 The majority of subdural hygromas are asymptomatic.[ahcmedia.com]
Urinary Incontinence
  • CASE DESCRIPTION: A 55-year-old man was admitted to our hospital complaining of headache, seizure, and urinary incontinence. He had a history of alcoholism and several hospitalizations for mild head trauma.[ncbi.nlm.nih.gov]
  • incontinence, showed abnormal magnetic resonance imaging (MRI) findings in their cervical spinal cords.[nature.com]
Headache
  • Hematoma thickness was significantly greater in patients without headache (P KEYWORDS: Chronic subdural hematoma; Headache; Pressure; Tension; Thickness[ncbi.nlm.nih.gov]
Seizure
  • Seizures often occur at the time the hematoma forms, or up to months or years after treatment. But medicines can help control the seizures.[nlm.nih.gov]
  • Exclusion criteria History of pre‐existing seizures.[doi.org]
  • The latter might then cause unintended skeletal muscle stimulation that might be misinterpreted in seizure-prone patients.[ncbi.nlm.nih.gov]
  • Chronic SDH may present with headaches, light-headedness, cognitive impairment, and seizures. 1 The risk of posttraumatic epileptic seizures (PTS) is higher in acute SDH.[jetem.org]
Confusion
  • Confusion and headache appears to be the most common presenting features as it is seen in as much as 90% to 56% of cases.[symptoma.com]
  • Depending on the size of the hematoma and where it presses on the brain, any of the following symptoms may occur: Confused or slurred speech Problems with balance or walking Headache Lack of energy or confusion Seizures or loss of consciousness Nausea[nlm.nih.gov]
  • BACKGROUND: The high recurrent rate of chronic subdural hematoma (CSDH) has consistently confused the neurosurgeons, and the role of atorvastatin in the management of CSDH has remained unclear over past decade, and atorvastatin seems to be a safe and[ncbi.nlm.nih.gov]
  • […] two weeks after bleeding begins Symptoms of subdural hematoma can include headache, confusion, change in behavior, dizziness, nausea and vomiting, lethargy or excessive drowsiness, weakness, apathy, and seizures.[pacificneuroscienceinstitute.org]
Stroke
  • Here, we present the case of a 64 year-old male whose prostate carcinoma's metastasis mimicked a subdural hematoma, and he suffered a middle cerebral artery stroke.[ncbi.nlm.nih.gov]
  • Página 311 - The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. ‎[books.google.es]
  • The Neuro-ICU cares for patients with all types of neurosurgical and neurological injuries, including stroke, brain hemorrhage, trauma and tumors.[neurosurgery.ucla.edu]
Lethargy
  • Symptoms include: Headache Weakness or numbness in arms, legs, or face Poor balance or coordination Change in behavior, emotions, or memory Drowsiness, lethargy, or coma Changes in vision Trouble speaking, swallowing, or communicating Nausea/vomiting[sharecare.com]
  • Presentations seen is dependent on the level of bleeding but general include siezures, apathy, weakness, lethargy, nausea, dizziness, behaviorual changes, confusion and severe headache.[symptoma.com]
  • […] symptoms may include: Bulging fontanelles (the soft spots of the baby's skull) Separated sutures (the areas where growing skull bones join) Feeding problems Seizures High-pitched cry, irritability Increased head size (circumference) Increased sleepiness or lethargy[nlm.nih.gov]
  • […] subdural hematoma include the following: A history of recent head injury Loss of consciousness or fluctuating levels of consciousness Irritability Seizures Pain Numbness Headache (either constant or fluctuating) Dizziness Disorientation Amnesia Weakness or lethargy[neurolaw.com]
  • Other symptoms include lethargy, memory impairment, confusion, weakness, nausea, vomiting, impaired vision and seizures. Patients with large hematomas may develop varying degrees of paralysis and coma.[neurosurgery.ucla.edu]

Workup

Following any form of head trauma, medical assessment including complete neurological examination should be conducted on the individual [8]. Most of the time, a CT scan or MRI scan will usually show significant subdural hematomas.

Subdural hematomas are seen mostly around the sides and tops of the parietal and frontal lobes. They are also seen in the posterior cranial fossa as well as near the falx cereberi and tentorium cerebeli. Subdural hematomas can expand along the skull unlike epidural hematomas.

Following a CT scan, subdural hematomas appear crescent-shaped with a concave surface away from the skull. However, they can have a convex appearance especially in the early stage of bleeding.

Treatment

  • Abstract Purpose To evaluate the effect of middle meningeal artery (MMA) embolization on chronic subdural hematoma (CSDH) and compare the treatment outcomes of MMA embolization and conventional treatment.[ncbi.nlm.nih.gov]

Prognosis

Mortality for cases of subdural hematoma has been put at 36 to 79% [5]. Most of the time, survivors are not able to regain previous levels of functionality especially following acute subdural hematoma that is serious enough to warrant surgical drainage. Positive outcomes in cases of subdural hematoma is seen 14 to 40% of the time.

Studies show that outcome is often favourable in younger patients [6].

Etiology

The main causes of acute subdural hematoma may include any of the following [2]:

The main causes of chronic subdural hematoma include the following:

  • Mild or severe head trauma
  • Acute subdural hematoma following surgey 
  • Spontaneous

Risk factors for chronic subdural hematoma include the following:

Epidemiology

Acute subdural hematomas have been noted to occur in 5 to 25% of patients that have severe head injuries with annual cases reported to be 1 to 5.3 cases per 100,000 population [3]. Some of the more recent studies show a higher incidence but this may be as a result of better imaging techniques.

There is sexual preponderance as SDH is seen more in men than in women. Male to female ratio is approximately 3:1. Men equally have a higher incidence of chronic subdural hematoma. The male to female ratio for chronic subdural hematoma is 2:1.

The incidence of chronic subdural hematoma is believed to be at its peak within the fifth to seventh decades of life.

Sex distribution
Age distribution

Pathophysiology

An acute subdural hematoma is a condition arising from a high-speed impact to the skull. This can lead to tearing of intracranial blood vessels [4].

Most of the time, the torn blood vessel is a bridging vein which connects the cortical surface of the brain to a dural sinus. In elderly individuals, the dural sinus may already be stretched due to brain atrophy.

Alternatively, a direct injury or laceration can damage a cortical vessel which may be a vein or artery. Acute subdural hematoma as a result of a ruptured cortical artery may be associated with only a minor head injury possibly without any associated cerebral contusion. Arterial injury may result in rapid neurological decline. In some instances, the ruptured cortical arteries were found located around the sylvian fissure. Generally, low-pressure venous bleeding from bridging veins occurs along the convexity. 

The head trauma may equally also cause associated brain hematomas or contusions as well as subarachnoid hemorrhage or diffusing axonal injury. Secondary brain injuries can include secondary haemorrhage, brain herniation, infarction or edema.

Chronic subdural hematomas develop over a time of days to weeks, often after minor head injury. They may not be discovered until they present clinically after a while.

Prevention

The best way to prevent SDH is to prevent head trauma by using adequate protective gear when engaging in risky activities [10]. As soon as the head suffers any form of impact, the individual should undergo medical evaluation. All underlying ailments must also be adequately taken care of.

Summary

A subdural hematoma (SDH) refers to the collection of blood outside the brain below the dura mater [1]. This condition is generally occurs due to severe head injuries and causes increased bleeding and pressure on the brain. This makes it a life-threatening condition. Subdural hematomas often require surgical drainage but in many cases, they resolve and stop without any external interventions.

Patient Information

Subdural hematoma refers to a situation where a vessle get ruptured between the brain and the dura matter. The dura matter refers to one of the three membrane layers that cover your brain. The leaking blood forms a kind of clot which compresses the tissues of the brain. If the clot (hematoma) continues to enlarge, a progressive decline in consciousness often follows and this often leads to death when untreated. Treatment is mostly via surgery.

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Last updated: 2019-07-11 21:31