The brain and the spinal cord are protected by three layers of meninges. The outermost layer is referred to as dura mater, the middle layer as arachnoid mater and the inner most layer as pia mater. Each of these meninges are separated by a thin space. Subdural space is the space between the dura mater and the arachnoid mater.
Subdural hematoma refers to clotting of blood in the subdural space which occurs usually following a head injury. This condition is a serious medical emergency and invariably requires immediate hospitalization. However, most patients with subdural hematoma make complete and quick recovery.
Causes Of Subdural Hematoma
In general, subdural hematoma is caused due to direct injury to the head like falling or being hit by a car, resulting in impact on the head. The head injury results in damage of one or more internal blood vessels in the subdural space, resulting in bleeding.
In some cases, subdural hematoma is associated with spontaneous bleeding which may be attributed to bleeding disorders like clotting problems, hemophilia, and thrombocytopenia or may be associated with the use of certain anticoagulant medications like warfarin.
In rare cases, subdural hemotoma may be attributed to subdural vessel aneurysm. An aneurysm is condition characterized by weakness in the arterial wall, which can tear easily on slightest trauma.
The condition is more frequently observed among the elderly (i.e. above the age of 60 years), babies especially exposed to physical abuse and chronic alcoholics.
Symptoms Of Subdural Hematoma
Subdural hematoma is characterized into three categories, namely acute- where symptoms develop immediately after an episode, subacute- where symptoms develop within 3 to 7 days after an episode and chronic- where symptoms develop about a week or two after the episode. Some of the common symptoms include,
- Drowsiness with severe headache, which may develop as soon as the hematoma is formed.
- Nausea and vomiting are associated symptoms which are observed with increasing pressure on brain tissue.
- Some individuals may develop an epileptic fit or seizure along with extreme weakness in the forearms and lower extremities.
- Confusion and difficulty in speech are other associated symptoms. In some cases visual disturbances may also develop.
In cases of chronic or subacute subdural hematoma, changes in behavior and personality may also be observed.
Treatment Options For Subdural Hematoma
The treatment of the condition would depend upon the severity of the injury, extent of bleeding or clotting and the presence of symptoms. A CT scan or an MRI scan is performed in order to detect the size of the hematoma along with its exact location. In most cases, surgical intervention is inevitable and delay in treatment would result in worsening of the symptoms.
There are two surgical options for the management of this condition. The first option is to burrow holes in the skull (referred to as burr holes), to allow the drainage of the accumulated blood. Bone wax is used to close these burrow holes. This procedure can be performed in an acute stage.
The second option is craniotomy, which involves the removal of a portion of the skull bone, so as to expose the brain and the meninges. This treatment is used in cases of increased intracranial pressure.
Homeopathic drugs like Arnica Montana can be used to complement the treatment, as the drug helps in natural absorption of extravagated blood and blood clots.