Subdural Hematoma: Causes, Signs and Treatment - Essay Sample

Introduction

A subdural hematoma is a condition where the collection of blood, hoards inside the skull but outside the brain, beneath the dura mater of the brain (Abe, Nagane & Shiokawa, 2017). Since the skull never expands, the accumulation of pressure brings about secondary severe brain damages. Pressure subjected to the brain results to signs of subdural hematoma. The backlog of pressure is known as Increased Intracranial Pressure (ICP) (Yadav & Bajaj, 2016). If there is no quick treatment, augmented ICP can cause altered consciousness, brain damage, and eventually, death. This paper will discuss in detail the causes, symptoms, diagnosis, treatment and prevention of subdural hematoma.

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Causes of Subdural Hematoma

The leading cause of Subdural Hematoma is head injuries. These damages on the head are usually very severe, like those coming from a car crash, high falls or even ferocious assaults. In some cases, subdural hematoma may be caused by the minor bumps on the head, although this is in few cases (Yadav & Bajaj, 2016). There is a subdural space that is between the skull and the brain. If any pressure is subjected to this space, bleeding may develop as a result of the damage of the brain blood vessels. The bleeding in return causes a subdural hematoma.

Furthermore, increasing age is another cause of subdural hematoma. Most people who are over 60 years are the one at high chances of being affected by this condition. The underlying reason for this is that when as people get of age, after 60 years, studies reveal that their brains start to shrink to some extent (Yadav & Bajaj, 2016). Shrinking of the brain due to age factor increase tension on the blood vessels of the brain just like a rubber band that is strained. The straining, in return, can cause severe damage and minor injuries to the brain that can bring about bleeding that can lead to the development of a subdural hematoma.

Another cause of subdural hematoma is the misuse of alcohol. When a lot of alcohol is taken for a considerable long time, it is also known to cause shrinking of the brain. (Yadav & Bajaj, 2016). Shrinking of the brain increases pressure on the blood vessels of the brain, which increase the vulnerability for brain damage, that cause bleeding which in turn lead to the development.

Furthermore, undergoing medication for blood thinning can cause a subdural hematoma. A blood-thinning medication is aimed in reducing blood clotting risks. In the process, the underlying narrative is that anticoagulant medicines are used which makes the blood to clot less easily, which increases the severity of bleeding in the head injuries resulting in a subdural hematoma. Brain aneurysms is another possible cause of subdural hematoma (Gaist & Pottegard, 2017). They usually cause bulging of the blood vessels in the brain, which can result in bursting, thus causing bleeding on the brain that bring about subdural hematoma.

Symptoms of Subdural Hematoma

The symptoms of subdural hematoma are mostly decided by the level of bleeding that occurs in the brain. When it is severe and sudden head injuries, subdural hematoma develops where an individual loses consciousness becoming comatose instantly (Levesque, 2018). In many cases, the affected individual may just look normal for a few days after the head injury; however, with time, they become confused gradually before losing their conscious days later. A slower bleeding rate is the underlying factor which in return causes a slow but enlarging subdural hematoma. In the cases where subdural hematomas grow slowly, noticeable symptoms may take even two weeks from the time bleeding started (Yadav & Bajaj, 2016).

The major symptoms include the following:

• Fluctuating levels of consciousness.
• Severe constant headaches.
• Partial loss of sensitivity towards the sensory stimuli.
• The amnesia that leads to losing the entire memory or inability to retrieve the information from a specific date.
• Severe body weakness and lethargy.
• Losing appetite.
• Difficulties while speaking characterized by slurred speech.
• Changing patterns of breathing.
• Epileptic seizure characterized by uncontrolled shaking movements that involve the entire body.
• In some cases, it leads to changes in the individual's personality.
• Gait abnormality in the eye movements.
• Tinnitus effects.
• Disorientation where the patient losses senses of time, direction, people and places.
• The victim can also lose muscle controls.
• Dizziness relating to lightheadedness and faint feelings.

The symptoms vary widely among people affected by subdural hematoma. The development symptoms are also affected by the subdural hematoma size, the age of a person, including other medical conditions (Yadav & Bajaj, 2016). In most cases, the symptoms are characterized by subtle changes in personalities more than the apathy.

Diagnosis of Subdural Hematoma

Subdural diagnosis is usually diagnosed based on the medical history, symptoms as well as the results of the brain scans. Based on the medical history, the doctor assessing a patient may suspect the presence of subdural hematoma if the patient had a head injury recently, and exhibit some major symptoms of subdural hematoma that includes advance confusion as well as worse headaches. The doctor will also seek to know if the patient is taking medication in preventing the blood clots like the warfarin and aspirins because the can cause a subdural hematoma. The doctor may also decide to take a blood test in assessing the ability of blood to clot. Furthermore, the doctor may want to know more history if the individual had a previous diagnosis of any condition with the same symptoms as those of subdural hematomas like dementia and brain tumour.

Regarding the assessment of the symptoms, the doctor will examine any signs of a head injury like cuts as well as contusions. Tests are also done to check how the pupils react to lights to determine any sign of brain injury. The Glasgow Coma Scale (GCS) is a tool to be used in checking the individual's conscious level that helps in determining the brain injuries severity (Yadav & Bajaj, 2016). The GSC scales help to determine the patient's verbal response on whether the individual can speak well or is capable of making any sounds at all. It also helps in monitoring responses that examine if the patient is capable of moving voluntarily in response to stimulations. The GSC also help to examine if the patients can open the eyes appropriately.

The other diagnosis is made through the brain scans known as the CT scan in confirming the diagnosis. The CT scan help in creating the detailed images of the internal body parts by the use of the X-rays as well as the computers. The scan is capable of revealing any blood collection between the skull and the brains. Some cases may require an MRI scan instead of CT in checking subdural hematoma. In this case, strong magnetic fields, as well as radio waves, are used to give a more detailed image of the internal body parts.

Treatment of Subdural Hematoma

Treatment of subdural hematoma greatly depends on how severe the condition is and ranges from waiting as you watch to extensive brain surgery. When the subdural hematoma is subtle, there is no specific treatment apart from mere observation. To check and monitor the improvement of subdural hematoma, frequent head imaging tests are performed. Severe and chronic subdural hematomas, however, need extensive head surgery to lower the pressure exerted on the brain.

Surgeons have several techniques for treating subdural hematoma. Firstly, it can be treated by the use of Burr hole trephination where there drilling of an opening on the skull where there is subdural hematoma, after which blood is suctioned via a hole. Secondly, craniotomy is another mode of treatment that involves removing a large part of the skull, with the aim of accessing to the subdural hematoma where the pressure is reduced (Yadav & Bajaj, 2016). After the procedure, the skull is then replaced. Thirdly, there is craniectomy treatment where a certain part of the skull is removed for some time, which makes the injured part to expand as well as swell preventing permanent damage. Severe subdural hematomas require machine support in breathing as well as life supports. Besides surgical treatments, other conservative treatments include tranexamic acid administration and oral administrations of corticosteroid (Holl & Dammers, 2019).

Preventions of Subdural Hematoma

A subdural hematoma is, as highlighted in this paper, caused by various factors that cause pressure or injury on the head. The very basic way is wearing a helmet while riding motorcycles. While in the car or any vehicle, people should at all times fasten their seat belts to lower any possible risks of head injuries in case an accident occurs. In those working in construction as well as other hazardous industries should always wear hats that are hard together with other safety equipment.

One cause of in subdural hematoma as indicated here is old age that is over 60 years. These elderly individuals should deploy extra care and caution in their daily activities to ensure that they do not fall. People should also have caution and ensure they have an appropriate balance to avoid falls. Furthermore, heavy appliances should be heavily bolted on walls to prevent possible tipping. Sharp table edges should be padded to avoid possible head injuries.

Conclusion

Head injuries usually result in a subdural hematoma. When pressure is subjected to the space between the skull and the brain, bleeding may develop due to the damage of the brain blood vessels, which in return causes a subdural hematoma. The symptoms of subdural hematoma are mostly decided by the level of bleeding that occurs in the brain. Subdural diagnosis is diagnosed based on the medical history, symptoms as well as the results of the brain scans. Treatment of subdural hematoma depends on how severe the condition is and ranges from waiting as you watch to extensive brain surgery. A subdural hematoma can be prevented by taking great caution on all factors that can cause injury to the brain like accident and falls.

References

Abe, Y., Nagane, M., & Shiokawa, Y. (2017). Outcomes of chronic subdural hematoma with preexisting comorbidities, causing disturbed consciousness. Journal of neurosurgery, 126(4), 1042-1046. Retrieved from https://pdfs.semanticscholar.org/4f3f/a0f0821b9272fd4906f95908d4bb3fdd0336.pdf

Gaist, D., & Pottegard, A. (2017). Association of antithrombotic drug use with subdural hematoma risk. Jama, 317(8), 836-846. Retrieved from https://jamanetwork.com/journals/jama/articlepdf/2605799/jama_Gaist_2017_oi_170004.pdf

Holl, D. C., & Dammers, R. (2019). Corticosteroid treatment compared with surgery in chronic subdural hematoma: a systematic review and meta-analysis. Acta neurochirurgica, 161(6), 1231-1242. Retrieved from https://link.springer.com/article/10.1007/s00701-019-03881-w

Levesque, M. (2018). Could Transient neurological Symptoms with subdural hematoma be explained by Cortical spreading depolarization Activity in Neurons? (CT-SCAN). Canadian Journal of Neurological Sciences, 45(s2), S18-S18.

Yadav, Y. R., & Bajaj, J. (2016). Chronic subdural hematoma. Asian journal of neurosurgery, 11(4), 330. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974954/