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A subdural hematoma is a blood clot that occurs on the brain. The tiny veins between the surface of the brain and its outer covering become stretched and torn after an injury allowing for blood to bleed and collect. Often times these develop as a result of a serious head injury. This is often referred to as an "acute" subdural hematoma. An acute subdural can be very serious and can cause severe damage if the bleeding fills the brain area very rapidly compressing the brain tissue. When this occurs emergent treatment is necessary to remove the blood clot and alleviate the compression on the delicate brain tissue.

A subdural hematoma can also develop with a mild brain injury, especially in the elderly. These can go unnoticed for days to weeks and are often called "chronic" subdural hematoma. In the elderly, the tiny veins become stretched and are more easily injured. Some subdural hematomas can occur without any cause. This too is more common in the elderly.

Risk Factors

  • Anticoagulant medication (blood thinners including aspirin)
  • Long term abuse of alcohol
  • Recurrent falls
  • Repeated head injury
  • Very young and very old age

Diagnosing

  • CT Scan (computed tomography)
  • MRI (magnetic resonance imaging)

Treatment

  • Close neurological observation to observe for any further bleeding is essential. For some people, the hematoma does not compress the delicate tissue to cause neurological damage. For those people, close observation may be all that is necessary. If the hematoma enlarges than emergency surgery may be warranted.
  • A Burr hole is a surgical operation where a small opening in the skull is created to allow for a drainage tube to be placed. As the body naturally breaks down the blood clot, the drainage tube helps to eliminate the clot. This does not require as large of an opening to perform and is considered less invasive than a craniotomy.
  • Emergency surgery (craniotomy) is often performed for acute subdural hematomas where there is compression on the delicate brain tissue. Surgery depends on the location of the subdural hematoma, the amount of blood and how the patient is responding (the neurological exam).

The best approach to treatment depends on the location and the amount of compression the blood clot is creating on the delicate tissues.

At Parker Adventist Hospital, we have skilled neurosurgeons with expertise to choose the right surgery based on an individual's needs. We have a specialized intensive care unit where the nursing staff is trained and skilled in giving the best care to the neuroscience patient.

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