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INTRODUCTION

Subdural hematomas are usually the result of a serious head injury. When one occurs in this way,
it is called an "acute" subdural hematoma. Acute subdural hematomas are among the deadliest of
all head injuries. The bleeding fills the brain area very rapidly, compressing brain tissue. This
often results in brain injury.

Subdural hematomas can also occur after a very minor head injury, especially in the elderly.
These may go unnoticed for many days to weeks, and are called "chronic" subdural hematomas.
With any subdural hematoma, tiny veins between the surface of the brain and its outer covering
(the dura) stretch and tear, allowing blood to collect. In the elderly, the veins are often already
stretched because of brain atrophy (shrinkage) and are more easily injured.

Some subdural hematomas occur without cause (spontaneously).

The following increase your risk for a subdural hematoma:

• Anticoagulant medication (blood thinners, including aspirin)


• Long term abuse of alcohol
• Recurrent falls
• Repeated head injury
• Very young or very old age

Symptoms And Symptoms

 A history of recenthead injury


 Loss of consciousness or fluctuating levels of consciousness
 Irritability
 Seizures
 Pain
 Numbness
 Headache (either constant or fluctuating)
 Dizziness
 Disorientation
 Amnesia
 Weakness or lethargy
 Nausea or vomiting
 Loss of appetite
 Personality changes
 Inability to speak or slurred speech
 Ataxia, or difficulty walking
 Altered breathing patterns
 Blurred Vision

 Deviated gaze, or abnormal movement of the eyes

In infants:

• Bulging fontanelles (the "soft spots" of the baby's skull)


• Feeding difficulties
• Focal seizures
• Generalized tonic-clonic seizure
• High-pitched cry
• Increased head circumference
• Increased sleepiness or lethargy
• Irritability
• Persistent vomiting
• Separated sutures (the areas where growing skull bones join)

MEDICAL MANAGEMANT

Always get medical help after a head injury. Older persons should receive medical care if they
shows signs of memory problems or mental decline. An exam should include a complete
neurologic exam.

A CT scan or MRI scan likely would be done to evaluate for the presence of a subdural
hematoma.

A subdural hematoma is an emergency condition!


Emergency surgery may be needed
to reduce pressure within the brain.
This may involve drilling a small
hole in the skull, which allows blood
to drain and relieves pressure on the
brain. Large hematomas or solid
blood clots may need to be removed
through a procedure called a
craniotomy, which creates a larger
opening in the skull.

Medicines used to treat a subdural


hematoma depend on the type of subdural hematoma, the severity of symptoms, and how much
brain damage has occurred. Diuretics and corticosteroids may be used to reduce swelling. Anti-
convulsion medications such as phenytoin may be used to control or prevent seizures.

Outlook (Prognosis)

Acute subdural hematomas present the greatest challenge, with high rates of death and injury.
Subacute and chronic subdural hematomas have better outcomes in most cases, with symptoms
often going away after the blood collection is drained. A period of rehabilitation is sometimes
needed to assist the person back to his or her usual level of functioning.

There is a high frequency of seizures following a subdural hematoma, even after drainage, but
these are usually well controlled with medication. Seizures may occur at the time the hematoma
forms, or up to months or years afterward.

Possible Complications

• Brain herniation (pressure on the brain severe enough to cause coma and death)
• Persistent symptoms such as memory loss, dizziness, headache, anxiety, and difficulty
concentrating
• Seizures
• Temporary or permanent weakness, numbness, difficulty speaking

Treatment

Medical Care

Although significant acute traumatic subdural hematoma requires surgical treatment, temporizing
medical maneuvers can be preoperatively used to decrease intracranial pressure. These measures
are germane for any acute mass lesion and have been standardized by the neurosurgical
community. They are discussed only briefly.

• As with any trauma patient, resuscitation begins with the ABCs (airway, breathing,
circulation).
o All patients with a GCS score of less than 8 should be intubated for airway
protection.
o After stabilizing respiratory function, perform a brief neurologic examination.
Adequate respiration should be initially addressed and maintained to avoid
hypoxia. Hyperventilation can be used if a herniation syndrome is present.
o The patient's blood pressure should be maintained at normal or high levels using
isotonic saline, pressors, or both. Hypoxia and hypotension, which are particularly
detrimental in patients with head injury, are independent predictors of poor
outcome.11
• Short-acting sedatives and paralytics should be used only when needed to facilitate
adequate ventilation or when elevated intracranial pressure is suspected. If the patient
exhibits signs of a herniation syndrome, administer mannitol 1 g/kg rapidly by
intravenous (IV) push.
• The patient should also be mildly hyperventilated (pCO2 ~30-35 mm Hg).
• Administer anticonvulsants to prevent seizure-induced ischemia and subsequent surges in
intracranial pressure.
• Do not give steroids, as they have been found to be ineffective in patients with head
injury.
NURSING CONSIDERATION

>MONITOR V/S

>EVALUATE PATIENT’S LEVEL OF DEPENDENCY

>ASSIST PATIENT FOR PROPER RANGE OF MOTION THAT IS APPROPRIATE FOR


HIM

>PLACE PT. ON A COMFORTABLE POSITION ON BED, ELIVATING HEAD

>GIVE MEDICATION ON TIME