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An acute subdural hematoma is an accumulation of blood inside the skull. The blood accumulation is specifically located between the dura, the fibrous covering of the brain, and the brain itself. There is very little extra room within the skull, so the build-up of blood puts pressure on the brain.

What are the signs and symptoms of the injury?

Symptoms of an acute subdural hematoma largely depend on the area of the brain compressed by the blood and the size of the hematoma. At first, a headache may be the most prominent feature. There may be weakness on one side of the body. Dizziness, walking difficulties, seizures, and or visual dysfunction may also occur.

If the subdural hematoma becomes large enough, a decrease in the level of consciousness may occur, leading to coma and death if neurosurgery is not performed immediately.

What are the causes and risks of the injury?

Usually, an acute subdural hematoma occurs following head trauma. During impact, the brain moves around inside the skull. Veins may tear, spilling blood into the subdural space. As people age, brains shrink slightly, so veins are stretched. Thus, the elderly are more susceptible to this type of injury.

What can be done to prevent the injury?

Proper medical treatment of conditions that affect consciousness and balance can help reduce the number of traumatic brain injuries due to falls, thereby in turn reducing the risk of acute subdural hematoma.

Other measures that can reduce head injuries include:

• wearing seat belts while riding in motor vehicles
• following sports safety guidelines for children, adolescents, and adults
• exercising control in high-speed sports, such as skiing

How is the injury recognized?

• cerebral angiogram
• cranial CT scan
• cranial MRI

What are the treatments for the injury?

A craniotomy, or brain surgery, may be indicated as the treatment for acute subdural hematoma. The skull is opened, and the hematoma is removed. Often where there is swelling of the brain, the piece of bone is left out. It may be replaced later if the individual recovers sufficiently. This practice can relieve the increased pressure inside the skull that frequently occurs.

Breathing is often controlled with a ventilator (an artificial breathing machine). Fluids and medicines are used to control blood flow in the brain. Anticonvulsant medicines are often used to prevent seizures.

Those who recover from surgery may be mildly or severely neurologically impaired. If so, long-term rehabilitation may be necessary. Some survivors are so neurologically impaired that long-term nursing care in a skilled nursing facility may be necessary.

What are the side effects of the treatments?

After surgery, many individuals have neurological impairments. They may have changes in consciousness level, motor skills, and activities of daily living. Seizure disorders are common, requiring medicines for control.

What happens after treatment for the injury?

After treatment, many individuals may be at risk for future injuries either because they are physically impaired or because they have problems with memory, judgment, and attention span.

Some of these changes may be permanent. Psychological counseling may be helpful for both the individual and the family. Any new or worsening symptoms should be reported to the healthcare professional.