Subdural hematomas are usually caused by a tearing of the blood vessels that lie between the brain and its lining. The incidence of subdural hematomas increases amongst older persons, primarily because of the shrinking that occurs when the brain atrophies with age. This makes the blood vessels more prone to injury. Taking medications such as blood thinners increases the risk of developing a subdural hematoma and even minor bleeding can become massive.
Recovery from a subdural hematoma will depend on the neurological state of the patient when the condition is first diagnosed, usually in the emergency department of a hospital. Individuals with good neurological function can expect good recovery after surgery for a subdural hematoma while the prognosis remains poor for those with poor neurological function.
The outcome will also depend upon the type of subdural hematoma. Subdural hematomas are classified as chronic and acute.
A chronic subdural hematoma (SDH) is caused by an old blood clot on the surface of the brain. SDH occurs more frequently in individuals over the age of 60, whose brains have begun to atrophy. In such individuals, even minor head injuries can result in a slow bleed that forms a clot. Many individuals have no recollection of any bump on the head that may have caused the clot.
Acute subdural hematomas are caused by clots that develop in the surface blood vessels of the brain due to head injuries that result in sudden jolts to the brain. They are the most lethal of all head injuries and are usually associated with the more severe head injuries.
Chronic subdural hematomas that are symptomatic are usually treated by drilling a hole into the skull and allowing the accumulated clots and blood to drain out through a catheter.
The recovery time after a chronic subdural hematoma will vary. Statistics show that 80% to 90% of patients with chronic SDH have significant improvements in brain function after the drainage. After the drainage, there is a possibility of residual fluid accumulating, but as long as the symptoms improve, further drainage will not be required.
The treatment for acute subdural hematomas will depend on the extent of the injury to the brain and will require immediate surgery. However, surgery may not be required in the case of SDHs that are smaller than 1 cm at the thickest point. Surgery is usually performed using a craniotomy, by creating a large opening in the skull to allow access to the site of the injury. Cerebral contusions are also removed during the craniotomy.
In the case of acute SDH, the outcome will vary widely. The mortality rate in such cases is high, up to 90%. Death in such cases usually is caused by the accompanying brain injury and pressure that develops on the brain in the days after the injury.
Up to 30% of all individuals with acute SDH will recover full or partial brain function after the surgery. Recovery from acute subdural hematoma may require extensive rehabilitation. The type of rehabilitation will depend upon the areas of the brain functioning that have been affected. The rehabilitation will usually be undertaken by a team of specialists and may include neurophysicians, speech therapists, physiotherapists, neurologists and specially trained nursing staff.
Recovery from acute SDH will also depend on the speed with which the individual receives treatment, age of the individual, the GCS score, presence of cerebral contusions and the degree of pressure on the brain. With all factors being equal, children with acute subdural hematoma have a much higher recovery rate.
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