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Friday, June 28, 2013

By Mike Martens


A subdural hematoma means that a bleed has formed beneath the dura layer of tisse inside of the skull. The dura matter and the arachnoid matter form a protective lining around the brain and a subdural hematoma occurs between these two layers.

Head trauma is the leading cause of subdural hematoma's. A secondary cause is related to brain atrophy that is most commonly seen in elderly patients or alcoholics. Both scenarios involve the veins that bridge these two layers of the brain. When these veins are stretched as can occur in either of these scenarios, the veins may rupture and cause internal bleeding to form a clot.

Head trauma can occur in any number of ways and to anyone. While brain atrophy is something that is typically seen in elderly people or alcoholics.

While subdural hematoma symptoms are often similar to those of many type of head injuries. A CT scan or MRI is quickly able to determine this type of bleed within the head.

Computer Tomography or a CT scan is a very quick procedure. Doctors order this test regularly for a large number of disorders. With respect to a brain injury, radiologists can quickly determine if a clot has formed in the meninges layers that protect the brain.

Severe head trauma is most often the cause of the most severe type of subdural hematoma which is referred to as acute. The other two classifications are sub-acute and chronic, both of which have a less serious immediate effect. Acute subdural hematoma's are often fast bleeds, which generate an enormous amount of inter-cranial pressure which can become life threatening in a very short amount of time.

The outlook for chronic subdural hematoma's is far greater. These bleeds occur at a much slower onset and because of their pace present a much better chance of being stopped prior to causing severe brain injury or death. Often chronic subdural symptoms may not even present themselves and these minor subdural bleeds will repair themselves over time.

Slow bleeds within the subdura can be much harder to diagnose. While acute bleeds are often distinguishable due to visual evidence of head trauma. The chronic bleed can happen over time and in 50% of cases, often the cause is never determined.

Treatment for subdural hematoma ranges from medical supervision to surgery. Less serious cases may correct themselves without intervention while acute cases require immediate medical evacuation to release pressure on the brain.

If pressure on the brain needs to be relieved due to severe symptoms and danger to longterm brain injury, surgery may be required. Burr hole surgery is preferred over opening the skull completely. A small incision is made in the scalp, a hand drill is used to burrow a small hole through which a drain can be placed to siphon the blood.

Craniotomy surgery involves accessing the clot by removing a larger section of the skull. A large incision is made in the scalp and it is folded back. A series of burr holes are drilled and then connected, that portion of the skull is removed. After cleansing of affected area, the bone flap is reinstalled with plates and screws and the scalp is stapled back in place.




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