Introduction to Subdural Haematoma
Subdural haematoma
A subdural haematoma is a collection of blood that builds up between the surface of the brain and the thin covering around it called the dura. It usually happens after a head injury, though sometimes it can develop slowly over time. Because the blood takes up space inside the skull, it puts pressure on the brain. This can be very serious and often needs urgent hospital treatment.
Symptoms of a subdural haematoma
The symptoms can appear straight away after a head injury, or they may develop gradually over days or weeks. Common symptoms include:
- A severe headache that does not improve with painkillers
- Feeling or being sick
- Confusion, memory problems or changes in behaviour
- Drowsiness or difficulty staying awake
- Slurred speech or swallowing problems
- Blurred or double vision
- Weakness or numbness on one side of the body
- Loss of balance or frequent falls
- Seizures (fits)
- Loss of consciousness, which may last a few seconds or much longer
When to seek emergency help
A subdural haematoma can be life-threatening. You should call 999 immediately if someone has hit their head and:
- Has not woken up after being knocked out
- Is very drowsy or struggling to stay awake
- Has a seizure (fit)
- Has weakness, numbness or problems speaking, seeing or walking
- Has bleeding or clear fluid coming from their ears or nose
- Has bruising around the eyes or behind the ears without direct injury
- Has had a serious accident such as a car crash or fall from height
Do not try to drive the person to hospital yourself. Wait for emergency services to arrive.
Diagnosis
If a subdural haematoma is suspected, doctors will carry out a brain scan, usually a CT scan or sometimes an MRI. This shows the size and position of the bleed and helps guide treatment.
Treatment options
The treatment depends on the size of the bleed and the symptoms.
Observation and medicines: Small haematomas may only need monitoring and medicines to reduce swelling.
Surgery: Most people with a significant subdural haematoma need surgery to remove the blood and relieve pressure on the brain. This can be done in two main ways:
- Burr hole drainage: the surgeon drills small holes in the skull and drains the blood.
- Craniotomy: a section of the skull is temporarily removed so the surgeon can remove the clot before replacing the bone.
MMA embolisation: In some cases, especially with chronic subdural haematomas, a newer treatment called middle meningeal artery embolisation may be used. This is a minimally invasive procedure where a doctor uses a thin tube inserted through an artery (often in the leg or wrist) to reach the small artery that supplies the haematoma. Tiny particles or liquids are then injected to block the artery. This helps stop the bleeding and reduces the chance of the haematoma coming back after surgery, or sometimes avoids the need for surgery altogether.
Recovery from a subdural haematoma
Recovery can take weeks or months. Some people may be left with long-term problems such as difficulty speaking, moving or remembering things. Seizures are also possible. Rehabilitation may involve physiotherapy, occupational therapy and speech and language therapy.
Severe subdural haematomas still carry a high risk of death, even with the best care.
Living with the effects of a subdural haematoma
The impact of a subdural haematoma can be challenging physically and emotionally. Support is available from healthcare teams, as well as from local or national brain injury groups. Talking with others who have gone through similar experiences can also help.
Would you like me to expand the MMA embolisation section into a separate heading, with more detail about how it is done and what benefits or risks patients should know about?