What you should know about traumatic subdural hematomas

Traumatic subdural hematomas are one of the most dangerous and deadly types of head injuries. Anyone who has a head injury from falling, a motor vehicle accident, or other traumatic cause can develop this lethal condition.

Research shows that patients are diagnosed with traumatic subdural hematomas in around 10–20% of all traumatic brain injury cases. The high risk is shown by the fact that subdural hematomas are present in up to 30% of all injuries that cause death.

What is a subdural hematoma?

The dura mater is a protective layer that covers the brain and spinal cord. When there’s an abnormal buildup of blood under the dura mater, it’s called a subdural hematoma. It’s easy to see how this can create a problem—there’s only so much room in the skull. If a hematoma grows too large, it will start to compress, push, and move brain tissue.

Severe subdural hematomas can cause a midline shift. This is when there’s so much extra hematoma or blood that it pushes brain structures from one side to the other. If the intracranial space continues to be filled with hematoma, the brain may eventually squeeze through the foramen magnum, the hole where the brain connects to the spinal cord. That’s called uncal herniation and can cause a massive brain injury and/or death.

Diagnosing subdural hematoma

Physicians and medical providers work up the possible diagnosis of subdural hematoma through orders for laboratory work (complete blood count) and diagnostic radiology.

If the patient is admitted to the hospital, repeated blood work track levels of hemoglobin and hematocrit, which can indicate active bleeding. Typical diagnostic radiology orders include a CT scan of the head. If there’s a subdural hematoma, radiologists will often notice a crescent-shaped lucency or abnormal area over the affected area of the brain. MRI scans of the head are also sometimes ordered when time allows.

Treating a subdural hematoma

Once there’s a diagnosis of subdural hematoma, the standard of care requires consultation with a neurosurgeon.

Some small bleeds may resolve on their own. Others, though, expand more rapidly and can cause increased intracranial pressure, which can lead to elevated blood pressure (hypertension),  bradycardia (slow heart rate), and irregular respirations. In these cases, emergency neurosurgery may be required to decompress the brain and address bleeding.

As in so many areas of medicine and healthcare, the key to the favorable outcome is prompt diagnosis and treatment. When nurses and physicians treating a patient with a traumatic head injury don’t fully consider the possibility of a subdural hematoma, it places patients at needless risk.

That’s what happened to a man in his 60s who fell at home and went to the emergency department (ER) at a Texas hospital. Let’s call him Joe. When Joe arrived at the ER, he reported his head injury and the ER nurse documented that he already had high blood pressure, an abnormally slow heart rate, and irregular breathing. He was admitted with orders for telemetry to monitor his cardiac function.

Over the course of his short hospitalization, Joe started complaining of terrible, intractable headache and his head wound from the fall also started seeping blood. The nursing staff didn’t notify a physician until Joe went into cardiopulmonary arrest. Despite efforts to resuscitate him, he died.

If you’ve been seriously injured because of poor care related to a subdural hematoma or head injury in Texas, then contact a top-rated, experienced Texas medical malpractice attorney for a free consultation about your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.