Subdural Hematoma Treatment: From Diagnosis to Recovery
Learn about subdural hematoma treatment, from diagnosis and symptoms to surgical options and recovery. Understand causes, risk factors, and prevention strategies.
Written by Dr. Dhankecha Mayank Dineshbhai
Reviewed by Dr. Mohammed Kamran MBBS, FIDM
Last updated on 15th Sep, 2025
Introduction
A subdural hematoma is a serious medical condition where blood collects between the layers of tissue surrounding the brain. Often resulting from a head injury, this pool of blood can put dangerous pressure on the brain, leading to severe symptoms and requiring urgent medical care. This guide will walk you through everything you need to know, from what causes this condition and how to spot its symptoms, to the various subdural hematoma treatments available and what the recovery process entails.
What is a Subdural Hematoma? The Basics Explained
A subdural hematoma (SDH) is a type of intracranial haemorrhage, or bleeding inside the skull. Specifically, it occurs in the subdural space—the area between the dura mater (the tough outermost membrane covering the brain) and the arachnoid mater (the middle layer). When tiny veins bridging this space tear, often due to a sudden jolt or head injury, blood leaks out and forms a hematoma, or a blood clot. As this clot expands, it presses on the sensitive brain tissue, causing a range of neurological symptoms.
Consult a Neurologist for Personalised Advice
Acute vs. Subacute vs. Chronic Subdural Hematoma
SDHs are categorised based on how quickly symptoms appear after the head injury:
- Acute: Symptoms appear severe and within minutes to hours. This is often due to a major trauma like a car accident and is a life-threatening medical emergency.
Subacute: Symptoms develop over several days to a week. - Chronic: Symptoms are mild, vague, and may not appear until weeks or even months after a seemingly minor head injury. This is common in older adults, where the brain has shrunk slightly (atrophy), stretching the bridging veins and making them more susceptible to tearing from even a minor bump.
What Causes a Subdural Hematoma? The Leading Factors
The primary cause of a subdural hematoma is a head injury. However, the severity of the injury needed to cause one can vary dramatically from person to person.
The Role of Head Trauma and Injury
Any event that causes the brain to move violently within the skull can tear the bridging veins. This includes:
- High-impact events: Car accidents, significant falls, and sports injuries.
- Low-impact events: In vulnerable individuals, a simple bump against a cabinet door or a minor fall from
- standing height can be enough to cause a chronic subdural hematoma.
Understanding Risk Factors: Who is Most Vulnerable?
While anyone with a head injury is at risk, certain factors make a person far more susceptible.
The Elderly and Brain Atrophy
As we age, our brains naturally shrink in size, a process called atrophy. This increases the space between the brain and the dura, stretching the bridging veins. These veins are then more fragile and can tear much more easily. This is why elderly subdural hematoma cases often occur after very minor trauma.
Blood Thinners and Anticoagulant Medication
Medications that prevent blood clotting, such as warfarin (Coumadin), clopidogrel (Plavix), aspirin, and direct oral anticoagulants (DOACs), are a major risk factor. While crucial for managing conditions like atrial fibrillation, they make it harder for the body to stop bleeding from a torn vein, allowing a hematoma to form and grow more easily.
Alcohol Use Disorder and Recurrent Falls
Long-term excessive alcohol consumption can lead to liver problems that impair blood clotting. It also increases the likelihood of falls and injuries, creating a perfect storm for developing a SDH.
Recognising the Signs: Symptoms of a Subdural Hematoma
The symptoms can be dramatic or deceptively subtle, making awareness crucial.
Symptoms of an Acute Subdural Hematoma
These are severe and appear rapidly:
- Loss of consciousness or coma
- Severe, sudden headache
- Confusion and drowsiness
- Nausea and vomiting
- Slurred speech
- Weakness or numbness on one side of the body
- Seizures
The Insidious Symptoms of a Chronic SDH
These can mimic dementia, stroke, or a brain tumour and often fluctuate:
- Persistent mild headache
- Memory loss or confusion
- Personality changes or irritability
- Difficulty walking or balance problems
- Lethargy or sleepiness
- Vision problems
How is a Subdural Hematoma Diagnosed?
If a subdural hematoma is suspected based on symptoms and history, immediate imaging is required. The gold standard is a CT scan (computed tomography), which quickly and clearly shows the presence, size, and location of fresh blood in the brain. In some cases, particularly for chronic SDHs, an MRI (magnetic resonance imaging) may be used for a more detailed view. If you or a loved one experiences a head injury followed by any of these symptoms, consult a doctor online with Apollo24|7 for immediate guidance on the next steps.
Subdural Hematoma Treatment Options: A Detailed Guide
The chosen treatment depends entirely on the size of the hematoma, the severity of the symptoms, and the patient's overall health.
Observation and Monitoring for Small Hematomas
Small, chronic subdural hematomas with minimal or no symptoms may not require immediate surgery. Doctors often choose a "watch-and-wait" approach with close monitoring through repeated CT scans. The body may eventually reabsorb the small amount of blood on its own.
Medications: Managing Symptoms and Underlying Causes
While drugs can't dissolve the clot, they are used to manage complications. Anti-seizure medications may be prescribed, and if the patient is on blood thinners, these will be reversed or paused (under strict medical supervision) to prevent further bleeding.
Surgical Interventions: When is Surgery Necessary?
Surgery is the primary treatment for a subdural hematoma when it is large or causing significant symptoms. The goal is to drain the blood and relieve pressure on the brain.
Burr Hole Trephination: Draining the Clot
This is a common and less invasive procedure for chronic SDHs. The surgeon drills one or two small holes (burr holes) in the skull, then inserts a catheter to drain the liquefied blood. This often leads to a rapid improvement in symptoms.
Craniotomy: Removing a Large Hematoma
For large, acute, or clotted hematomas, a larger opening is required. In a craniotomy, a section of the skull is temporarily removed to allow the surgeon to access and remove the hematoma. The bone flap is then replaced. This is a more extensive surgery, but it is necessary for severe cases.
The Road to Recovery: What to Expect After Treatment
Recovery is highly variable. Younger patients with a minor SDH may recover fully, while elderly patients often have a longer, more complex journey.
Potential Complications and How They Are Managed
Complications can include seizures, infections, brain swelling, and the potential for the hematoma to recur. Close follow-up with a neurologist or neurosurgeon is essential to manage these risks. If your condition does not improve after surgery or you experience new symptoms, book a physical visit to a doctor with Apollo24|7 for a comprehensive evaluation.
Rehabilitation: Regaining Lost Function
Many patients, especially those who had severe symptoms, require rehabilitation. This may include:
- Physical therapy: To improve strength, balance, and walking.
- Occupational therapy: To relearn daily activities like dressing and cooking.
- Speech-language therapy: To address problems with speech, language, or swallowing.
Can You Prevent a Subdural Hematoma?
Prevention focuses on minimising risk factors:
- Fall Prevention: Especially for the elderly. Remove tripping hazards, install handrails, and ensure good lighting.
- Manage Medications: If on blood thinners, have regular check-ups to ensure the dosage is correct and discuss fall risks with your doctor.
- Protective Gear: Always wear seatbelts and use appropriate helmets for sports, cycling, and riding motorcycles.
- Moderate Alcohol Consumption.
Conclusion
A subdural hematoma is a formidable medical challenge, but outcomes have significantly improved with modern diagnostic tools and surgical techniques. The key to a successful recovery lies in early recognition of its often-subtle signs and seeking immediate medical attention. Understanding the causes, symptoms, and available subdural hematoma treatments empowers you to act decisively. Whether it's taking preventive measures for an ageing parent or knowing when to go to the emergency room after a head injury, this knowledge is powerful. If you have any concerns about a past head injury or ongoing symptoms, do not hesitate to consult a healthcare professional for a proper evaluation. Your vigilance could make all the difference.
Consult a Neurologist for Personalised Advice
Consult a Neurologist for Personalised Advice
Dr. Aditendraditya Singh Bhati
Neurosurgeon
18 Years • MBBS(2004), DNB Neurosurgery(2014); MNAMS; Fellow Neuroendoscopy
Delhi
Apollo Hospitals Indraprastha, Delhi
(100+ Patients)
Dr. Ganeshgouda Majigoudra
Neurologist
10 Years • MBBS, MD ( GENERAL MEDICINE) DM (NEUROLOGY)
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
Dr Rajashekar Mummadi
Neurologist
3 Years • MBBS, DNB General Medicine, DRNB Neurology
Hyderabad
Dr Ram's Neuro Clinic, Hyderabad
Dr. E Prabhakar Sastry
General Physician/ Internal Medicine Specialist
40 Years • MD(Internal Medicine)
Manikonda Jagir
Apollo Clinic, Manikonda, Manikonda Jagir
(125+ Patients)
Dr S Selvin
Neurologist
10 Years • MBBS, MD, DM (Neurology), FINR fellowhsip in Interventional Neuro Radiology
Chennai
Apollo Speciality Hospitals Vanagaram, Chennai
Consult a Neurologist for Personalised Advice
Dr. Aditendraditya Singh Bhati
Neurosurgeon
18 Years • MBBS(2004), DNB Neurosurgery(2014); MNAMS; Fellow Neuroendoscopy
Delhi
Apollo Hospitals Indraprastha, Delhi
(100+ Patients)
Dr. Ganeshgouda Majigoudra
Neurologist
10 Years • MBBS, MD ( GENERAL MEDICINE) DM (NEUROLOGY)
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
Dr Rajashekar Mummadi
Neurologist
3 Years • MBBS, DNB General Medicine, DRNB Neurology
Hyderabad
Dr Ram's Neuro Clinic, Hyderabad
Dr. E Prabhakar Sastry
General Physician/ Internal Medicine Specialist
40 Years • MD(Internal Medicine)
Manikonda Jagir
Apollo Clinic, Manikonda, Manikonda Jagir
(125+ Patients)
Dr S Selvin
Neurologist
10 Years • MBBS, MD, DM (Neurology), FINR fellowhsip in Interventional Neuro Radiology
Chennai
Apollo Speciality Hospitals Vanagaram, Chennai
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Frequently Asked Questions
Can a subdural hematoma heal without surgery?
Yes, small chronic subdural hematomas with minimal or no symptoms can sometimes be managed without surgery through careful observation. The body may slowly reabsorb the blood over time, monitored with repeated CT scans.
What is the prognosis for an elderly person with a subdural hematoma?
The prognosis varies widely. Age, overall health, the size of the hematoma, and how quickly treatment was received all play a role. While recovery can be more challenging for the elderly, many can achieve a good quality of life with appropriate treatment and rehabilitation.
How long is the recovery after burr hole surgery?
Hospital stay is typically short (a few days). Overall recovery can take several weeks to months. Patients are advised to avoid strenuous activity and follow up regularly with their neurosurgeon to ensure healing and monitor for recurrence.
What are the signs of a rebleed after subdural hematoma surgery?
Symptoms of a recurrence are similar to the initial symptoms: worsening headache, increased drowsiness, new weakness, slurred speech, or vomiting. Any new or returning neurological symptom after surgery requires immediate medical attention.
Is a subdural hygroma the same as a hematoma?
No. A hygroma is a collection of cerebrospinal fluid (CSF) in the subdural space, not blood. However, a hygroma can sometimes tear vessels and later develop into a hematoma, so it also requires monitoring.