Understanding what is a subdural hematoma

Recently in the news, Alex Trebek, game show host of the 33-year long running show Jeopardy, was diagnosed with a condition called a subdural hematoma in December after he suffered a fall two months earlier in October.  He had surgery to remove blood clots from his brain that occurred due to his fall.  He is expected to make a full and complete recovery and has plans to return to the show in mid-January.

What is a subdural hematoma?

A subdural hematoma occurs when blood collects between the layers of the tissue surrounding the brain.  The most common cause of this condition is usually severe head injuries or trauma to the head.  The trauma can damage tiny veins within the meninges.   

The bleeding in a subdural hematoma is under the skull and outside of the brain and not within the brain itself.  As blood builds up between the brain and the brain’s outer lining accumulating, there is no place for it to go so eventually pressure on the brain increases. 

Subdural hematoma can be a life-threatening problem as it can compress the brain.  Some subdural hematomas stop and resolve spontaneously while others require surgical drainage. 

Who is more likely to develop a subdural hematoma?

As stated above, trauma to the head is the main cause of subdural hematomas.  In young, healthy people, they are generally started by a significant impact to the head such as in a high-speed vehicle accident.

In older people, they may develop this after only a minor trauma such as falling out of a chair and hitting their head.  They can also be more common in people who take blood thinning medications such as Coumadin, those who abuse alcohol, or people who have seizures. 

Types of subdural hematomas

Not all subdural hematomas act alike.  A person can have an acute subdural hematoma which is bleeding that develops shortly after a serious blow to the head.  In this situation, blood will accumulate quickly within minutes to hours, causing pressure to rise within the brain.  This is a serious, life-threatening scenario as it can result in loss of consciousness, paralysis, or death.

The other type of subdural hematoma is a chronic subdural hematoma. This form is more common in older people in which the head trauma is often a minor condition.  The bleeding will develop slowly over a period of weeks to months.

Symptoms

Symptoms of an acute subdural hematoma can be the following:

·      Severe headache

·      Weakness on one side of the body

·      Seizures

·      Changes in vision or speech

Chronic subdural hematomas have more subtle symptoms that can continue for more than a month before a diagnosis is made.  The symptoms can also mimic strokes or brain tumors.  The symptoms include:

·      Mild headache

·      Nausea or vomiting

·      Change in personality

·      Memory loss

·      Loss of balance or difficulty walking

·      Double vision

·      Weakness, numbness or tingling in arms or legs

Treatment for subdural hematomas

If the hematoma is an acute subdural hematoma, it will require immediate medical attention.  Emergency surgery is usually necessary to drain the hematoma and to control bleeding. 

For a chronic subdural hematoma, only some of them require emergency surgery.  If the hematoma is large or causing neurological symptoms, most physicians will recommend surgery.  If the hematoma is small and is causing minimal to no symptoms, then treatment may be bed rest, medications, and observation for any signs of changes. 

One consideration with subdural hematomas is that people who develop them are at risk of seizures, which can also still occur even after the hematoma is treated.

Outlook and prognosis

Depending on which type of hematoma a person is diagnosed with will determine the prognosis.

For those with an acute subdural hematoma, the outlook is usually poor.  If they do survive, they may be left with permanent neurological damage.  The prognosis is improved if the person did not lose consciousness, is younger than age 50, did not abuse alcohol, have any other associated brain injuries, and received prompt medical treatment.

Individuals who have a chronic subdural hematoma have a much better prognosis. Most people are able to resume normal functioning within time.