Subdural Hematoma: An Overview

Shivendra Pratap Singh


High Court Lucknow

Medico Legal

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Published on: 13 Aug, 2023

A subdural hematoma is a serious medical condition characterized by the accumulation of blood between the protective layers (meninges) that surround the brain, specifically between the dura mater and the arachnoid mater. This condition often results from traumatic brain injury and can lead to increased intracranial pressure, which can be life-threatening if not addressed promptly.

1. Causes of Subdural Hematoma:

The primary cause of a subdural hematoma is trauma to the head. This can range from a severe blow during an accident or fall to a minor bump for those particularly at risk. The trauma leads to the tearing of veins in the subdural space, leading to bleeding and hematoma formation.

Factors increasing risk include:

  • Advanced age, due to the brain shrinking and pulling away from the dura, making veins more susceptible to tearing.
  • Long-term alcohol misuse.
  • Blood-thinning medications.
  • Repeated minor head injuries.

2. Types of Subdural Hematoma:

  • Acute Subdural Hematoma: Develops rapidly, usually due to severe head trauma. Symptoms can manifest within hours.
  • Subacute Subdural Hematoma: Symptoms start days or even weeks after the injury.
  • Chronic Subdural Hematoma: Can result from minor trauma and may take weeks to months to develop.

3. Symptoms:

Symptoms can vary based on the type and severity of the hematoma but may include:

  • Headache
  • Weakness or numbness on one side of the body
  • Difficulty speaking or slurred speech
  • Dizziness or confusion
  • Personality changes or unusual behavior
  • Seizures
  • Loss of consciousness

4. Diagnosis:

A subdural hematoma is typically diagnosed using imaging tests:

  • CT Scan: Quick and effective in visualizing the presence of blood.
  • MRI: Provides detailed images and can detect older or smaller hematomas.

5. Treatment:

Treatment is dependent on the size and location of the hematoma:

  • Small Hematomas: If not producing severe symptoms, might be monitored closely without immediate intervention.
  • Surgical Treatments:
    • Burr Hole Trephination: Small holes are drilled into the skull to drain the blood.
    • Craniotomy: A section of the skull is removed to access and remove the hematoma.
    • Craniectomy: Part of the skull is removed to allow a swelling brain to expand without being compressed.

Medications might also be administered to reduce swelling in the brain or control seizures.

6. Prognosis and Recovery:

The outcome for individuals with a subdural hematoma depends on the hematoma’s size, location, and the promptness of treatment. Quick medical intervention can greatly improve the prognosis. Rehabilitation therapies, such as physical, occupational, and speech therapy, can aid in the recovery process.


A subdural hematoma is a severe medical condition requiring prompt attention. Awareness of its signs and symptoms can lead to early diagnosis and better outcomes. Those at higher risk, particularly the elderly or those on blood-thinning medications, should be vigilant and seek medical care if they suspect they might have a subdural hematoma.


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