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Subdural haematomas
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A subdural haematoma is a blood clot that forms underneath one of the protective layers covering the brain, known as the dura mater. This type of bleeding is usually caused by trauma such as a fall, an assault or a road accident.
The brain
The brain controls and coordinates body functions consciously and unconsciously. It is protected primarily by the skull, which acts as the first barrier. As a barrier the skull works very well, but the brain also needs cushioning from inside the skull. Otherwise, even the slightest impact to the head could cause the brain to hit the inside of the skull, resulting in serious damage.
A system of protective coverings of the brain, called the meninges, provides the cushioning required. The meninges are divided into three separate layers:
- Pia mater – closest to the brain
- Arachnoid mater – on top of the pia mater
- Dura mater – on top of the arachnoid mater and next to the skull.
Although the meninges’ primary role is to protect the brain, they also contain blood vessels. These blood vessels may rupture as a result of injury.
Subdural haematoma
A subdural haematoma is a blood clot, which forms between the dura mater and the arachnoid mater. It is usually caused by some kind of direct blow to the head as a result of a fall, an assault or a road accident.
Types of subdural haematoma
There are three main types of subdural haematoma:
- Acute – develops within 24 hours of initial trauma.
- Acute on chronic (subacute) – develops within two to 10 days of the initial trauma.
- Chronic – develops 10 days after the initial trauma.
Symptoms
The symptoms of a subdural haematoma depend on the severity of the bleed, but can range from a headache to death. Possible symptoms include:
- Severe headache
- Lethargy
- Confusion
- Slurred speech
- Visual disturbances
- Limb weakness
- Neck stiffness.
If any unusual symptoms occur after a blow to the head, see your doctor immediately.
Diagnosis
If left untreated, a subdural haematoma can grow and press on the brain. Pressure on the brain can be harmful. This pressure forces the brain against the skull, causing damage to the brain as well as hindering the brain’s ability to function properly. This inability to function properly can lead to long-lasting brain damage or, if left untreated, death.
Tests generally used to diagnose a subdural haematoma are:
- CT scan – computed tomography
- MRI scan – magnetic resonance imaging.
Treatment
Possible treatment options include:
- Conservative – if the subdural bleed is too small to operate on and is not causing damage to the brain, the neurosurgeon may advise against surgical drainage of the bleed. Careful observation is carried out for a specified period of time to ensure that there is no further bleeding.
- Surgical – if the bleed is causing damage to the brain, surgical intervention is required. A neurosurgeon performs this procedure by cutting a hole into the skull in order to provide access to the brain. This is needed to repair any ruptured blood vessels and to remove the blood clot. After the operation is finished, the bone is replaced, the muscle and skin are stitched up, and a drain is placed inside the brain to remove any excess blood left from the surgery.
Where to get help
Things to remember
- There are layers underneath the skull that protect the brain from serious harm.
- The blood vessels in these covering layers may become damaged after a blow to the head.
- If any unusual symptoms occur after a blow to the head, see your doctor immediately.
You might also be interested in:
Acquired brain injury.
Aneurysm.
Bleeding.
Cerebral haemorrhage.
Stroke is a brain attack.
Want to know more?
Go to More information for support groups, related links and references.
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This page has been produced in consultation with, and approved by:
Howard Florey Institute
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Copyight © 1999/2010 State of Victoria. Reproduced from the Better Health Channel (www.betterhealth.vic.gov.au) at no cost with permission of the Victorian Minister for Health. Unauthorised reproduction and other uses comprised in the copyright are prohibited without permission.
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This Better Health Channel fact sheet has passed through a rigorous approval process. For the latest updates and more information visit www.betterhealth.vic.gov.au.
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Fact sheet currently being reviewed.
Last updated: June 2008
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Subdural haematomas are blood clots formed underneath one of the protective layers of the brain. They usually occur after a traumatic blow to the head such as a fall, assault or road accident. Symptoms can include severe headache, lethargy, confusion, slurred speech, visual disturbances, limb weakness and neck stiffness. Untreated subdural haematomas can be fatal...
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Subdural haematomas - Better Health ChannelSubdural haematomas are blood clots formed underneath one of the protective layers of the brain. They usually occur after a traumatic blow to the head such as a fall, assault or road accident. Symptoms can include severe headache, lethargy, confusion, slurred speech, visual disturbances, limb weakness and neck stiffness. Untreated subdural haematomas can be fatal...
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The information published here was accurate at the time of publication and is not intended to take the place of medical advice. Please seek advice from a qualified health care professional.
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