Subdural Haemorrhage - Medical Negligence Lawyers
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A subdural haemorrhage is a bleed that occurs outside the brain but inside the confines of the dura mater. The most common cause of a subdural haemorrhage is a significant head injury. Complications include increased pressure of the intracranial space, which leads to coma and death. Subdural haemorrhages are life-threatening unless they resolve spontaneously. They require surgery to correct in most cases.
The bleeding in a subdural haemorrhage is between the arachnoid layer and the dura layer. The bleeding is not within the brain itself. Because it is close to the brain, however, the brain cavity swells, which causes the neurological findings seen in this condition. The swelling leads to herniation of the brain into the foramen magnum, interfering with the brainstemís ability to control the heart and respirations. In essence, it is not compatible with life.
The most common cause of a subdural haemorrhage is a serious head injury. This can be caused by an assault, a motor vehicle accident, sports injury or a fall from a great height. Subdural haemorrhages can be acute, because of having a sudden onset, subacute, having a medium length of onset and chronic, having a slow onset of symptoms.
A risk factor for having a subdural haemorrhage includes being on blood thinners. Another risk factor is having a bleeding disorder. Minor head trauma can cause a subdural bleed in these people. In chronic subdural haemorrhages, the symptoms may not appear in the patient for several days to several weeks. This type of hematoma is more prevalent in the elderly who have brain shrinkage and stretching of tiny veins beneath the dura. A spinal tap is an unusual cause of a subdural hematoma.
There are several symptoms of a subdural haemorrhage. The symptoms seen are largely due to the rate of bleeding of the haemorrhage. The symptoms include:
- Immediate loss of consciousness and coma in patients with severe head trauma
- In chronic disease, the symptoms are slow in onset and show up as confusion, which progresses to coma in a few days
- In slow growing haemorrhages, the onset of symptoms occurs as late as two weeks or more post-incident
- Headache of a varying nature
- Behavioral changes
- Feeling drowsy or tired
- Weakness, which can be diffuse or in certain extremities
- Being apathetic
The symptom of subdural haemorrhage can vary widely, depending on the size of the blood clot, the location of the blood clot and the rapidity with which the blood clot grows.
The subdural haemorrhage needs to be diagnosed soon after the patient arrives in the emergency room. The best test is a CT scan of the head because blood shows up easily in such a scan. In a MRI exam, the subdural haemorrhage is more easily seen but it is a more expensive test and is less likely to be available at smaller hospitals. Less commonly, an angiogram is necessary. This uses dye and x-rays to find the source of the bleeding.
The treatment of subdural haemorrhages is dependent on their severity. Small lesions can simply be watched, while serious, life-threatening bleeds need surgery.
Some treatments include:
- Burr hole treatments: This is an emergency procedure that makes a nickel-sized hole in the skull so that blood can be sucked out successfully.
- Craniotomy: This is when a large section of bone is removed so that the blood clot can be evacuated.
- Craniectomy: In such cases, the patient has a section of bone removed for a long period of time to let the swelling ebb and flow so that it can finally abate.
Some patients need to be on a ventilator to manage their vital signs while ill or in a coma. If there are bleeding issues, they need to be corrected so that the bleeding stops. Medication to control swelling on the brain and to decrease inflammation may be necessary.
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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here