Subdural Hematoma By Sean Stives

What is it? Subdural = beneath (visceral to) the dura Hematoma = a blood clot Damage caused by increased pressure on the brain Often fatal: 50-90% mortality rate Accounts for 10-20% of traumatic brain injuries Can often accompany a cerebral contusion

How is it caused? Rapid acceleration or deceleration of the brain tears the veins around the skull  Brain's inertia competes with the skull's movement like a passenger in a motor vehicle  Puts force on bridging veins that help keep brain in place  If the force becomes too great, the vein tears.  Primary mechanisms: whiplash & blunt force trauma

Subdural Hematoma Click Me Arrow Points to a subdural hematoma on a CT scan

Two Types of Subdural Hematomas Acute Clot is new More common version Chronic Clot is old Often in patients aged 60+ Brain atrophy causes shrinkage More space = less pressure Clots are larger but signs and symptoms show up later Happen more easily

Signs and Symptoms May take hours, days, or weeks for signs and symptoms to show. (Because veins are torn. Not arteries.) Headache that increases over time Exercise-induced headaches Dizziness, nausea, hearing & visual disturbances, concentration issues, and unequal pupils Low Glasgow Coma Scale scores

Treatment & Recovery True medical emergency  Get person to a hospital immediately Hematoma appears on a CT scan. Usually requires rapid surgical intervention Brain surgery patients' recoveries vary  ~20-30% regain some or all brain function  young adults, those with a GCS score > 6 or 7, and those without multiple brain contusions have the best chances at a successful recovery

What to remember Caused by a rapid acceleration/deceleration mechanism Blood clot beneath the dura mater of the cranial cavity Tears veins around the brain Requires immediate medical attention