Subdural Haematoma

A subdural haematoma is a type of bleeding that occurs in the brain, specifically between the dura mater (the outermost meningeal layer covering the brain and spinal cord) and the arachnoid mater (the middle meningeal layer). This condition is characterized by the accumulation of blood in the subdural space, which can lead to increased intracranial pressure and potentially life-threatening complications.

Causes

Subdural haematomas are typically caused by:

• Traumatic brain injury (TBI), such as a fall or motor vehicle accident, which can cause the bridging veins to rupture and bleed into the subdural space.
• Spontaneous bleeding, often due to anticoagulant therapy, vascular malformations, or other underlying medical conditions.
• Tumors, infections, or other diseases that affect the brain and its surrounding tissues.

Symptoms

The symptoms of a subdural haematoma can vary depending on the severity and location of the bleeding. Common symptoms include:

• Headache, which may be severe and worsening over time.
• Nausea and vomiting.
• Confusion, disorientation, or altered mental status.
• Weakness, numbness, or paralysis of the face, arm, or leg.
• Seizures.
• Dilated pupils or changes in vision.

Diagnosis

Subdural haematomas are typically diagnosed using:

• Computed Tomography (CT) scans, which provide detailed images of the brain and can detect bleeding in the subdural space.
• Magnetic Resonance Imaging (MRI), which can also detect bleeding and provide more detailed information about the brain and its surrounding tissues.
• Clinical evaluation, including a physical examination and medical history, to assess for signs of trauma or underlying medical conditions.

Treatment

Treatment for subdural haematomas depends on the severity and location of the bleeding. Options may include:

• Conservative management, with close monitoring and supportive care, for small, asymptomatic haematomas.
• Surgical evacuation, using a craniotomy or burr hole procedure, to remove the accumulated blood and relieve pressure on the brain.
• Medications, such as anticonvulsants or corticosteroids, to manage symptoms and prevent further complications.

Complications

If left untreated or inadequately managed, subdural haematomas can lead to:

• Increased intracranial pressure, which can cause herniation of the brain and potentially life-threatening complications.
• Brain damage or death due to lack of oxygen and nutrients.
• Seizures, hydrocephalus, or other neurological disorders.

Prognosis

The prognosis for subdural haematomas depends on the severity and location of the bleeding, as well as the promptness and effectiveness of treatment. Generally:

• Mild haematomas may resolve with conservative management and have a good prognosis.
• Large or symptomatic haematomas require surgical intervention and may have a poorer prognosis due to increased risk of complications.