Subdural Hemorrhage - Medical Malpractice LawyersLEGAL HELPLINE: ☎ 855 804 7125
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When a person suffers a subdural hemorrhage, it is due to a traumatic brain injury (TBI) which occurs beneath the dura mater, the leather-like layer just under the skull.
Subdural: means underneath the dura mater
Hemorrhage: refers to bleeding
A subdural hemorrhage is, therefore, blood leaking into the area known as the meninges. The definition of a subdural hemorrhage, also known as a hematology, is essentially damage to, or tearing of, the blood vessels that feed the brain. This results in blood leaking into the cavity between the brain and the skull.
Subdural hemorrhages usually result from some form of trauma to the head, like a blow or a knock from a fall. It should be noted that there are often no external symptoms at first, as the effects can present between 48 hours and 2 years later.
A small subdural hemorrhage, while still a serious injury, causes less damage because the blood will often slowly re-absorb over a period of months. However, any hemorrhage can gradually grow larger over time, and the pressure on the brain can manifest as anything from a bad headache to coma and death if it remains untreated.
Subdural hemorrhages are not limited to any age group, as they can happen at any stage of life. But, whatever the age, immediate medical intervention can help decrease the likelihood of sustaining permanent brain damage.
Causes and Symptoms
The most common cause of a subdural hemorrhage is from a head injury, but it has, however, been known to be present at birth and among those with weak vascular systems.
Symptoms tend to vary as the condition worsens. It mostly starts with a persistent headache, followed by periods of confusion and drowsiness. Then, as the bleeding gets worse, paralysis or weakness on one side, along with a constant tiredness persist. Obvious symptoms that occur when the condition is becoming critical are enlarged or asymmetric pupils, seizures, unconsciousness and, finally, coma. Medical staff should always be notified about any history of head injury, because the symptoms could be misdiagnosed as a stroke.
In a baby, warning signs may involve increased head size, a bulging fontanelle (the soft spots on an infant's skull), vomiting, irritability, stupor and convulsions.
It is sometimes difficult to diagnose a chronic subdural hemorrhage as it is very similar some other medical conditions (such as stroke); however, there is one unmistakable sign: a slow lapse into unconsciousness.
It can be positively identified by an MRI (magnetic resonance imaging) or by a CT (computed tomography) scan.
Misdiagnosis or late diagnosis of a subdural hemorrhage can give rise to a medical malpractice compensation claim.
Small hemorrhages often do not show any symptoms, so minimal medical attention is necessary as they will heal themselves over the course of a few weeks.
Non-surgical treatment involves the use of anti-inflammatory and diuretic drugs, which can bring brain swelling under control.
Symptomatic hemorrhages need to be surgically drained and this is accomplished by drawing off the liquid blood from holes drilled into the skull.
The larger, more life threatening hemorrhages may require the removal of the section of the skull directly above the haemorrhage to clear away the blood and tie off the leaking vein. After surgery, anticonvulsant drugs (such as phenytoin) are used to help control or to prevent convulsions.
Negligent Treatment of a subdural hemorrhage can give rise to a medical malpractice compensation claim.
If the patient is treated early enough, a full recovery is usually made. Headaches, memory loss, attention deficit, anxiety and light-headedness may persist for some time. Symptoms of subdural hemorrhage in adults will usually diminish within six months. Children mostly recuperate faster.
Because a subdural hemorrhage usually follows a head injury, only prevention of head injury can prevent a subdural hemorrhage.
Subdural Haematoma - Medical Malpractice
A subdural haematoma or haemorrhage is a severe collection of blood that builds up underneath the dura of the brain. The dura is a tough fibrous covering over the brain and spinal cord. A subdural haemorrhage can be termed acute, subacute and chronic. Acute subdural haematomas are extremely serious because of a great amount of bleeding occurring very quickly so that pressure builds up in the brain and a herniation can occur, which results in death. Brain herniation is when the brain pushes through the large foramen at the base of the skull and permanently damages the breathing centers of the brain and you stop breathing.
Particularly in the elderly, a small trauma can cause a subdural haematoma. There can be few or no symptoms for several days, resulting in a subacute subdural haematoma. There can be many weeks or months without obvious symptoms other than a headache or increasing dementia, called a chronic subdural haematoma.
The bleeding of a subdural haematoma happens when small veins between the brain's surface and the dura or lining of the brain get broken. When they tear, they can lead to rapid bleeding between the brain and the dura or the bleeding can be minor, resulting in subacute or chronic injury. In the elderly, the brain is relatively shrunken so the veins are already stretched and break easily. In rare situations, the subdural haemorrhage can happen without any injury at all and is called idiopathic subdural haematoma.
You have a greater risk of getting a subdural haematoma if you are on blood thinners, have some type of disability that results in falls, abuse alcohol chronically, or engage in sports or other activities that can cause head trauma, whether single head traumas or repetitive head traumas. The very young or the very old are at risk for subdural haematomas.
The symptoms of a subdural haematoma include a severe headache, difficulties in balance, speech slurring, confusion, lethargy nausea, vomiting, coma or loss of consciousness, seizures that didn't exist before, double vision, weakness or changes in vision. You can have weakness on a part of the body or numbness or a part of the body. Stroke-like symptoms are not out of the question. Children and adults have these symptoms while infants have different symptoms. Infants can have problems feeding, seizures which can be generalized or focal, a bulging of the fontanelles (soft spots), weakness, a high pitched cry, vomiting, irritability or separation of the sutures of the skull.
Subdural haematomas are medical emergencies that require immediate neurological and neurosurgical intervention. Doctors need to do a CT scan or MRI scan of the head to see where the brain is bleeding and how much pressure is on the brain. CT scans are better tests because blood shows up easily on this type of scan. CT scans can show imminent herniation as well and this means that emergency surgery to decompress the brain is necessary. A burr hole can be made into the skull to let the blood drain out very quickly. A craniotomy or open brain surgery can be done to stop the bleeding and fix the problem easier. When a craniotomy is done, the skull cap or a portion thereof is removed, the work is done and the skull piece is replaced back on the brain in order to heal.
Medications are also used to treat subdural haematomas. Steroids shrink swelling and inflammation of the brain. Mannitol is used to decrease the amount of excess liquid in the brain so the swelling is reduced. Medications are given to control seizures, particularly Dilantin or phenytoin.
There are many complications of subdural haematomas, including brain herniation, which is almost always fatal. Chronic seizures or epilepsy are a result of having a subdural haematoma. Permanent weakness or stroke-like symptoms can be secondary to having a subdural haematoma. It all depends on how big the subdural haematoma is and where it is located on the skull. Subdurals that are treated promptly do better than those in which the haematoma is delayed.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here