Acute (subacute) subdural hematoma

Alternative names:

acute/subacute subdural hematoma; acute/subacute subdural hemorrhage; epidural hematoma

Symptoms:

• Recent injury or trauma to the head
• Loss of consciousness after original injury
  • May or may not regain consciousness for a period of time
  • Decrease in alertness after initial awakening
• Drowsiness
• Headache, steady or fluctuating
• Impaired vision
  • Visual loss (blindness)
  • Left eye
  • Right eye
• Eyes retract into the socket (enophthalmos)
• Eyelid drooping on one side only (unilateral)
• Decreased sensation or numbness
  • Lower extremities (right leg or left leg)
  • Upper extremities (right arm or left arm)
  • Face (right side of face or left side of face)
  • Individual is aware of reduced ability to feel (sensory deficit)
• Inattention to environment on the same side as the reduced sensation
• Loss of movement (paralysis)
  • On only one side of the body
  • The individual is aware of movement difficulty (motor deficit)
• Confusion, delirium
• Changes in personality
  • Irritability
  • Apathy
• Decreased memory
• Slowed thought processes
• Impaired speech or language
  • Loss of the ability to read but can still understand speech
  • Unable to repeat a phrase
  • Slurred speech (dysarthria)
  • Unable to use muscles for speech but muscles are not paralyzed
  • Speech is missing, mute
  • Impaired ability to name objects (anomia)
  • Comprehension of spoken word is impaired
• Withdrawal from social interaction
• absent sweating on one side of the forehead

Symptoms peculiar to infants less than 6 months old:

• Fontanelles - bulging
• Increased head circumference
• Sutures - separated
• Irritability
• high-pitched cry
• Setting-sun sign
  • The eyes appear to look downward and there is a small amount of white sclera visible above the iris; it may be easiest to see when the infant is changed from a sitting position to supine (lying face up).
• Focal seizures
• Generalized tonic-clonic seizure

Signs and tests:

Consult the health care provider promptly for any head injury that results in even a brief loss of consciousness, or if other symptoms are present after head injury even without loss of consciousness. Acute/subacute subdural hematoma may be diagnosed after the health care provider has ruled out other possible causes of symptoms that occur after a head injury, such as intracerebral hemorrhage.

Examination may show focal neurologic deficits (localized, specific brain function changes such as decreased movement or sensation). Reflexes may be abnormal. There may be signs of increased intracranial pressure. The skull may be tender to when gently tapped on one or both sides. Examination may reveal a need for emergency surgery to relieve pressure within the head without further testing to pinpoint the location and type of injury.

In abused infants, there may be a history of poor feeding and/or failure to thrive. Retinal hemorrhages are peculiar to infants with subdural bleeding that results from shaking (shaken baby syndrome) or from blows to the head.

Tests:

• A head CT scan confirms the diagnosis of subdural hematoma and will pinpoint the exact location of the hematoma.
• This disease may also alter the results of a cranial MRI.

Update Date: 10/08/99
Updated by: adam.com editorial