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Tuesday, 2 July 2013

Subdural Hematoma

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By Mike Martens


A subdural hematoma is a bleed that forms a clot inside of the head. This bleed is categorized as a subdural hematoma when it occurs between the dura mater and the arachnoid matter surrounding the brain.

The most common cause for a subdural hematoma is trauma to the head. The bleeding can occur when veins in this space are stretched and torn such as what happens in a severe impact. Brain atrophy, a shrinking of the brain, can also cause enough stress on these veins to induce a rupture and a bleed.

While head trauma is pretty self explanatory, we have all witnessed events where someone has undergone a head injury that has the potential to result in damage to the brain. Brain atrophy is a little different. Atrophy means "to shrink" this is known to occur in the brain to seniors and those affected by alcoholism.

Symptoms of a subdural hematoma can be very similar to those known for concussions. Anyone experiencing nausea, dizziness and memory loss should receive immediate medical attention where a CT scan or MRI can quickly determine if a bleed has occurred within the head.

MRI and CT scan imaging can be done very quickly to determine if a blood clot is forming within the protective layers of the brain. Depending on the circumstances, a contrast dye is sometimes used to improve the visibility of what is happening within the body.

Severe head trauma is most often the cause of the most severe type of subdural hematoma which is referred to as acute. The other two classifications are sub-acute and chronic, both of which have a less serious immediate effect. Acute subdural hematoma's are often fast bleeds, which generate an enormous amount of inter-cranial pressure which can become life threatening in a very short amount of time.

The outlook for chronic subdural hematoma's is far greater. These bleeds occur at a much slower onset and because of their pace present a much better chance of being stopped prior to causing severe brain injury or death. Often chronic subdural symptoms may not even present themselves and these minor subdural bleeds will repair themselves over time.

While the acute trauma injuries are instant and life threatening, the chronic subdural hematoma may take weeks, months, or even years of bleeding at a very slow rate before they start to cause enough pressure within the head to provoke symptoms.

Treatment for subdural hematoma ranges from medical supervision to surgery. Less serious cases may correct themselves without intervention while acute cases require immediate medical evacuation to release pressure on the brain.

Burr hole surgery is typically the first resort when medical evacuation of the subdural hematoma is required. A catheter is placed into the blood clot after a small hole is drilled through the skull. Often this drain is left for a period of time to allow as much drainage as possible.

A craniotomy is a larger procedure performed under general anesthetic and is considered major surgery. A bone flap is removed from the skull in order to physically removed the clot. This procedure is necessary when the burr hole surgery would not be effective. After the area is properly cleaned, the dura is sewn back up and the bone flap is secured with plates and screws.




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