What to Know About Subdural Hematoma

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For families who've watched Jeopardy! for years, host Alex Trebek is practically a member of the household. Which is why his announcement earlier this month that had be taking medical leave was a cause of deep concern for many viewers.

Trebek revealed that he had been diagnosed with a subdural hematoma after sustaining a fall and would need to undergo surgery. But just what is a subdural hematoma, and how serious is it?

Subdural hematomas are pools of blood that collect between brains protective covering (called the dura) and the brain itself. They form after a head injury, such as a car accident or a fall.

David Rosen, MD, a neurosurgeon at AdventHealth, explains more.

It's important to distinguish that there are two types of subdural hematomas. Acute subdural hematomas develop and cause symptoms immediately or within hours of a head injury. They are usually diagnosed by a CAT scan in the ER and often require emergency surgery. Chronic subdural hematomas can be more complex because they commonly present four to six weeks after the head injury took place. In this case, the subdural hematoma slowly enlarges over time. When it finally presents symptoms, the patient often presents to the ER or their primary care doctor.

Dr. Rosen adds, In both types, subdural hematomas range in severity. Since acute subdural hematomas usually occur after a significant accident or injury, patients generally know about it and receive medical attention immediately, but with the chronic type, the most common symptoms that prompt delayed medical attention is a headache or stroke like symptoms such as numbness, speech changes or problems with comprehension that occur over the course of days to weeks.

If not found and treated, they can quickly become life-threatening.

An important distinction to make is that some subdural hematomas do resolve on their own, such as those that are small or not causing symptoms, Dr. Rosen advises. In these cases, we generally follow up with CAT scans and exams to make sure the patient is healing.

But for the larger subdural hematomas or those that are causing symptoms, the treatment is typically a surgical procedure. We perform two main types of surgeries: a craniotomy or a smaller burr hole incision, both with the goal to drain the blood from the subdural hematoma and release the pressure on the brain.

With these surgeries, most patients are on the road to recovery with a positive prognosis after about five days of observation and recovery in the hospital’s Intensive Care Unit.
Thankfully, a large percentage of patients that have this condition and get prompt treatment make robust and complete recoveries. It's not like a stroke, where one can be left with major deficits in brain and motor function, explains Dr. Rosen.

According to Dr. Rosen, the population most affected by subdural hematomas are older adults. As we age, the brain shrinks and atrophies, but skull stays the same size. This creates more space between the brain and the skull, which is a major risk factor for chronic subdural hematomas in particular.

Although, subdural hematomas can also occur in babies and other individuals prone to falls. Long-term alcohol use, blood-thinning medications (such as aspirin or warfarin) and certain medical conditions that affect the blood clotting ability can increase a personal risk.

In these vulnerable individuals, even minor falls and bumps to the head can cause chronic subdural hematomas, which is one reason why so many go unnoticed sometimes for days, weeks or even months.

Sometimes, the signs of a subdural hematoma are best noticed by a friend or loved one. Here are some of the most common symptoms to look for:

  • Confusion
  • Slurred speech
  • Balance problems
  • Headache
  • Memory loss
  • Weakness, numbness or lethargy
  • Vision problems
  • Nausea or vomiting
  • Seizures
  • Loss of consciousness

If you've recently suffered a fall and have one or more of the risk factors listed above its probably a good idea to see a doctor for an evaluation.

Anyone who develops new symptoms after hitting their head, even if it’s a week or a month later, should seek medical help, recommends Dr. Rosen.

Knowing subdural hematoma risks grow in the elder populations, especially in the eight decades of life, it's also important to be aware of your aging loved one's environments and take precautions to reduce fall risk in their environments, he adds

And Dr. Rosen speaks from experience. AdventHealth is the largest neurosurgical hospital in Florida, so subdural hematomas are a very common diagnosis treated by Dr. Rosen and his fellow medical staff. We treat several hundred subdural hematomas per year, and most of the patients we treat are in the elder population.

As for Trebek, he underwent surgery in December and says he expects to return to the hosting podium very soon.

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