Subdural hemorrhage

Subdural hemorrhage

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What Is a Subdural Hemorrhage?

A subdural hemorrhage describes a type of bleeding that causes irritation and pressure to the brain. A subdural hemorrhage is given that name because it is located in a region called the subdural space. The subdural space is the space located between the surface of the brain and the dura, which is a layer of protective tissue between the brain and the skull.

What Is the Dura?

The meninges are 3 layers of tissue, the pia, the arachnoid and the dura.

The meninges surround the brain and spinal cord, providing a protective cushion. There are also nutrients and blood vessels running through the meninges. A type of fluid, called cerebrospinal fluid, lubricates, protects and nourishes the brain and spinal cord . The meninges envelope the cerebrospinal fluid that flows around the brain and spinal cord.

Of the 3 layers of meninges, the dura is the furthest from the brain itself and closest to the skull. The dura is also the thickest, strongest  and most protective of the 3 layers.

What Causes a Subdural Hemorrhage?

A subdural hemorrhage may be caused by head trauma, a tumor or an infection, although it can also occur without a known cause. Blood thinners may increase the chances of subdural hemorrhage, especially among those who are elderly.

When a subdural hemorrhage happens without an obvious cause, it is described as a spontaneous hemorrhage.

What Are the Symptoms of a Subdural Hemorrhage?

Subdural hemorrhages can cause a variety of symptoms, depending on their size and specific location within the skull. 

Symptoms can include any combination of the following:

  • Headaches- this is the most common symptom of a subdural hemorrhage, because the pressure from the blood on the brain is likely to cause pain.
  • Dizziness
  • Lethargy
  • Loss of consciousness- when a subdural hemorrhage is large, it can disrupt the normal functioning of the brain.
  • Seizures- severe pressure on the brain can disrupt the brain's normal electrical activity, resulting in a seizure.
  • Weakness of one side of the face, arm and/or leg- pressure on one side of the brain may impair strength on the opposite side of the body.
  • Vision changes
  • Confusion
  • Collapse or death- this is a rare consequence of subdural hemorrhage. When the blood is located near the brainstem, important functions, such as breathing, may be disrupted.

What Should I Expect From a Subdural Hemorrhage?

A subdural hemorrhage is typically caused by bleeding of a vein.

The bleeding may occur slowly, and might not produce severe symptoms right away. Over time, the symptoms may develop gradually as the blood produces gradually increasing pressure on the brain from the outside.

Most of the time, subdural hemorrhages are small or medium in size, and do not progress to cause severe symptoms. The blood itself may clear up on its own. Most people recover from a subdural hemorrhage and experience resolution of symptoms without any medical intervention.

However, a subdural hemorrhage can become large enough to push against the brain, causing significant neurological symptoms.

If a subdural hemorrhage involves significant amounts of blood, it can cause a stroke, due to the pressure. In severe situations, the blood may cause significant pressure, leading to loss of consciousness, or even death if the blood produces pressure on vital parts of the brainstem that control breathing and other survival mechanisms.

What Is a Subdural Hematoma?

A subdural hematoma is a large collection of blood in one region of the brain. Typically, a subdural hematoma is caused by a subdural hemorrhage.

What Is the Treatment For a Subdural Hemorrhage?

If the bleeding is mild to moderate, often no treatment is necessary.

Generally, it is recommended to avoid strenuous activity that could increase the risk of head trauma while the blood is clearing up.

Sometimes, the blood must be removed through a surgical procedure.

A Word From Verywell

A subdural hemorrhage is a significant medical problem, although, most people experience good recovery. If you have a subdural hemorrhage that does not require surgery, it may take months for you to experience complete recovery. If you have had a subdural hemorrhage that requires surgical intervention, you might not experience complete recovery until a few months after your procedure.

As you are recovering, you may experience fatigue, headaches, or neurological symptoms that are expected to gradually improve.

Reference:

Imaging of Subdural Hematomas, Carroll JJ, Lavine SD, Meyers PM, Neurosurg Clin N Am. 2017 Apr;28(2):179-203

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