What is Traumatic Acute Subdural Hematoma? Causes and Significance.

What is Traumatic Acute Subdural Hematoma?

A violent blow to the head can tear blood vessels on the brain surface. Blood then spills into the space between brain and the overlying tissue layer called dura mater (in short: dura), forming a puddle of blood (hematoma) under the dura, called sub-dural hematoma (SDH). The blood usually coagulates into a solid blood clot within minutes. This clot then puts pressure onto the active bleeding site. The hemorrhage or extravasation may then come to a stop, at least temporarily. If the hemorrhage does not stop, the increased brain pressure will result in rapid death.

CT head shows right holohemispheric and interhemispheric blood and brain compression and midline shift. The patient crashed his motor vehicle and suffered direct impact to the head. Additional CT images showed bifrontal parenchymal hemorrhagic contusions, and biconvexity traumatic subarachnoid hemorrhages. Patient survived with emergency surgery. He suffered permanent brain damage from the initial severe traumatic injury.

What causes this condition?

Traumatic brain injury, frequent causes include falls from height and motor vehicle accidents (MVAs).

What are the symptoms and signs of acute SDH?

Brain injury and hemorrhage impair wakefulness and mental function, causing headache, confusion, somnolence, stupor, coma and ultimately brain herniation and death. Focal neurological deficits include hemiparesis or hemiplegia or hemisensory loss, aphasia or visual loss etc.

How do you diagnose Acute Subdural Hematoma?

CT scan of the head.

Is surgery needed for acute SDH?

Any brain compression and brain shift necessitate surgical decompression.

What surgery is done for acute SDH?

Craniotomy and removal of the hematoma. Surgery reduces the pressure onto the brain. Hemostatic agents and clips help repair tears in ruptured blood vessels. The surgeon cauterizes any active hemorrhage. Craniotomy means that the surgeon fits the skull bone back in place after removing the blood clot.

Craniectomy becomes necessary if the brain is too injured and swollen to put the skull bone back. The surgeon removes the skull flap and the scrub technician wraps it sterilely in a freezer bag. The explanted skull bone stays in a deep freezer until the surgeon places it back several months later in a cranioplasty (skull repair) operation. The trauma victim needs to survive and recover from the injury first, and the brain needs to fully relax before it is safe to repair the skull with cranioplasty.

How serious is traumatic acute SDH?

Death is a common outcome even with surgery and best of care. The hematoma in itself may not necessarily be fatal unless there is significant brain compression or worsening shift. The initial blow to the head however often results in irreversible brain damage and ultimate death. A few decades ago fewer than 1/3 of people survived this kind of injury. The stats are not substantially better today.

What do you want to know about Acute Subdural Hematoma?

Please leave your questions and comments below. We will read every comment because your input is very important for the understanding and awareness of this condition.

Leave a Comment