Diagnosis and treatment of subdural haematoma

Diagnosis is made based on clinical history and by a computerised tomography scan (CT). If the subdural haematoma is small and the symptoms are not severe it may be left to reabsorb by itself with no surgical intervention. During this time the patient would be carefully monitored for any deterioration.

If symptoms are severe, such as decreased level of consciousness, confusion etc, surgical intervention may be required. This can be done in two ways, either by a burr hole or craniotomy.

Burr holes are holes drilled through the skull over the area of the bleed which allow the haematoma to be ‘sucked’ out. The procedure requires a small incision through the skin which is closed by a few stitches or staples. Burr holes are less invasive than a craniotomy and are often used for an acute subdural haematoma’s as the blood tends to be more ‘runny’ before it has clotted too much.

A craniotomy is a larger opening in the skull and allows greater access to the brain. This method is more frequently used to remove chronic subdural haematoma’s as over time the blood will have become more solid and therefore is difficult to be ‘sucked’ out through a burr hole. There is more information about the procedure in our booklet entitled Craniotomy.

Following both procedures the patient will be closely monitored and regular neuro observations performed. The reason for this is to check the person’s conscious level, it involves the nurses shining a light in the eyes, testing strength of arms and legs and also asking simple questions such as name and age. From these observations a Glasgow Coma Score (GCS) is recorded, any decrease in this score may indicate that the clot was reforming or the brain was being compromised in some way. A patient who has a subdural haematoma is often nursed lying flat, this aims to prevent the recollection of the blood which can occasionally happen if the original site of rupture has not healed. This can occur particularly in the case of elderly patients who have sustained a chronic subdural haematoma. The patient may also have a drip (intravenous fluids) to maintain hydration and will be given pain killers for any headaches they may be experiencing.

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