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Subdural Hematoma - Important And Concise Information

Bob Carroll — Mon, 24 Oct 2005 07:21:09 GMT

Subdural hematoma is frequently the result of a traumatic head injury. A subdural hematoma is a collection of blood on the surface of the brain. It lies beneath the outer covering (the dura) of the brain and the brainâ€™s surface. Use safety equipment and safety precautions at work and play to minimize the risk of a head injury.

A subdural hematoma, frequently the result of a traumatic head injury, is a serious medical condition. It deserves a review that is concise and understandable. A posting at Info For Health qualifies and is repeated here.

Subdrual Hematoma

Definition: A subdural hematoma is a collection of blood on the surface of the brain. It lies beneath the outer covering (the dura) of the brain and the brain's surface.

Alternative Names: Subdural hemorrhage

Causes

Subdural hematomas are usually the result of a serious head injury. When this is the cause, they are referred to as "acute" subdural hematomas. Subdural hematomas can also occur spontaneously or after a very minor head injury, especially in the elderly. These go unnoticed for many days to many weeks, and are referred to as "chronic" subdural hematomas. The terms acute, subacute, and chronic reflect how long it takes blood to collect.

Acute traumatic subdural hematomas are among the most lethal of all head injuries (up to 50% lethality). They expand very rapidly, leaving little room for the brain, and are associated with brain injury.

Subdural hematomas occur in about 15% of all head traumas. Tiny veins between the surface of the brain and its outer covering (the dura) stretch and tear, allowing blood to collect. In the elderly, the veins are often already stretched because of brain atrophy (shrinkage).

Risks include:
Head injury
Very young or very old age
Anticoagulant medication (blood thinners)
Chronic alcohol use

Symptoms

Recent injury or trauma to the head
Loss of consciousness after original injury
Headache, steady or fluctuating
Weakness, numbness or inability to speak
Slurred speech
Nausea and vomiting
Lethargy
Seizures

In infants:

Bulging fontanelles
Increased head circumference
Separated sutures
Irritability
High-pitched cry
Focal seizures
Generalized tonic-clonic seizure

Exams and Tests

Always seek medical attention following a significant head trauma or mental deterioration in the elderly. The evaluation should include a complete neurologic exam.

Any of the following may prompt the physician to order a brain imaging study:
Signs of weakness
Numbness
Inability to speak
Slurred speech
Persistent headache
Abnormal level of consciousness
Recent intellectual deterioration in an elderly person, even in the absence of head injury)

A CT scan or MRI scan would likely be done to evaluate for the presence of a subdural hematoma.

Treatment

A subdural hematoma is an emergency condition! Treatment includes lifesaving measures, controlling symptoms, and minimizing or preventing permanent brain damage.

Medications vary according to the type and severity of symptoms and the extent of brain damage. Diuretics may be used to reduce swelling. Anticonvulsant medications such as phenytoin may be used to control or prevent seizures.

Emergency surgery may be required to reduce pressure within the brain. This may involve drilling a small hole in the skull to relieve pressure and allow the hematoma to drain. Large hematomas or solid blood clots may need to be removed through a larger opening in the skull (craniotomy).

Outlook (Prognosis)

The outlook following a subdural hematoma varies widely depending on the type of head injury, the size of the blood collection, and how quickly treatment is obtained.

Acute subdural hematomas present the largest challenge, with high rates of death and injury. Subacute and chronic subdural hematomas have good outcomes in most cases, with symptoms going away after the blood collection is drained.

There is a high frequency of seizures following a subdural hematoma, but these are usually well controlled with medication.

Possible Complications

Temporary of permanent weakness, numbness, difficulty speaking
Seizures
Brain herniation
Persistent symptoms such as memory loss, dizziness, headache, anxiety, and difficulty concentrating

When to Contact a Medical Professional

Serious head injuries and complications like subdural hematoma require emergency medical attention. Call 911 or go immediately to an emergency room. Spinal injuries often accompany head injuries, so always consider immobilizing the patient's neck if the patient must be moved before medics arrive.

Prevention

Use safety equipment and safety precautions at work and play to minimize the risk of a head injury. For example, use hard hats, bicycle or motorcycle helmets, and seat belts.

Originally posted at InjuryBoard by Bob Carroll

The NFL And Brain Injury

Bob Carroll — Fri, 19 Jan 2007 06:25:00 GMT

The NFL probably would rather not talk about brain damage suffered by its players as we approach the Super Bowl. However, there was this little matter of the player who ended up with the characteristics as those of early-stage Alzheimer's victims. Excerpts from the New York Times article:

Expert Ties Ex-Player's Suicide to Brain Damage

Since the former National Football League player Andre Waters killed himself in November, an explanation for his suicide has remained a mystery. But after examining remains of Mr. Waters's brain, a neuropathologist in Pittsburgh is claiming that Mr. Waters had sustained brain damage from playing football and he says that led to his depression and ultimate death.
The neuropathologist, Dr. Bennet Omalu of the University of Pittsburgh, a leading expert in forensic pathology, determined that Mr. Waters's brain tissue had degenerated into that of an 85-year-old man with similar characteristics as those of early-stage Alzheimer's victims. Dr. Omalu said he believed that the damage was either caused or drastically expedited by successive concussions Mr. Waters, 44, had sustained playing football.
Dr. Omalu's claims of Mr. Waters's brain deterioration -- which have not been corroborated or reviewed -- add to the mounting scientific debate over whether victims of multiple concussions, and specifically longtime N.F.L. players who may or may not know their full history of brain trauma, are at heightened risk of depression, dementia and suicide as early as midlife.

Originally posted at InjuryBoard by Bob Carroll

Serious Brain Injury Sustained By Skateboarder Who Hitched A Ride

Bob Carroll — Sat, 27 Jan 2007 03:44:35 GMT

Just about every week I learn of new ways for people to be seriously injured. Not too long ago it was tube kiting that burst on the scene. (Sitting on large inner-tube shaped "kites" towed behind motorboats at high enough speeds to become airborne.) This week it is skitching. (Hitching a ride by grabbing a car while on a skateboard.)

The details of a skitcher who sustained a brain injury in Florida are reported by my fellow InjuryBoard blogger, Charles Monnett, III, of Charlotte, North Carolina.

Skitching Teenager Ends Up With Brain Injury

A 14-year-old boy is recovering from a serious brain injury he received after he fell while riding a skateboard while hanging onto a car. This dangerous activity goes by the name of skitching.
Alex Hanson is recovering at Tampa General Hospital. He is a student at Charlotte High School. He was skitching at the 13000 block of Orchid Drive in Punta Gorda when he sustained the life threatening brain injury. He can now feed himself, speak a little, sit up and continues to improve.

I know the more traditional sporting activities of water skiing and roller-skating have caused serious injuries, but I have to believe skitching should be reserved for James Bond movies.

Originally posted at InjuryBoard by Bob Carroll

Traumatic Brain Injury Requires Maximum Rehabilitation Effort

Bob Carroll — Mon, 15 Jan 2007 13:29:29 GMT

Recovery from traumatic brain injury (TBI) requires a major rehabilitation effort. Often, a significant part of legal representation of the injured person is devoted to assuring maximum care is obtained. One example of the need for an advocate of proper rehabilitation is provided by a recent study which shows that some particular groups of brain injured persons can sometimes experience a poorer outcome than others with similar injuries.

Functional outcomes from inpatient rehabilitation after traumatic brain injury: how do hispanics fare?

CONCLUSIONS: Hispanics showed significantly reduced long-term functional outcome after rehabilitation relative to whites. Rehabilitation professionals should recognize the possible impact of individual differences and diverse sociodemographic, injury, and rehabilitation characteristics so that differential health outcomes among TBI survivors can be reduced or eliminated.

Every victim of a traumatic brain injury deserves the best of care so that the outcome is maximized. Hispanics, whether in Florida or elsewhere in the U.S., should not experience a reduced long-term functional outcome relative to any other group.

Originally posted at InjuryBoard by Bob Carroll

The More Subtle Consequences Of A Head Injury

Bob Carroll — Mon, 19 Sep 2005 10:13:41 GMT

From England comes the results of a study of long term consequences of traumatic brain injuries from the perspective of the victims themselves.

“Head injury leads to a wide range of emotional, social, cognitive and physical difficulties, with primary care teams and various speciality services providing support and care to those who have returned to a home environment. Whilst most areas of outcome mentioned by survivors are already well known, areas of outcome where more attention might be deserved include: difficulties with group conversations in individuals who have no problems with one-to-one conversations, sensitivity to concerns relating to changes in physical appearance, the consideration of sense of loss amongst individuals following injury and the various misconceptions and negative reactions from others.”

From England comes the results of a study of long term consequences of traumatic brain injuries from the perspective of the victims themselves.

The study, available in full text at BioMedCentral, approached its subject by actually talking at length with persons who had experienced the consequences of a head injury for one to ten years.

These reported problems should enlighten the attorney seeking full compensation for a client who has sustained a traumatic head injury. They are subtle and subjective, to be sure, but should be included in the evidence presented in support of a claim.

I would add the observation from the representation of the injured victims and their families that family relationships, especially those between a husband and wife, are impacted adversely in many situations. Despite the best efforts of spouses some marriages are weakened or even destroyed. On the positive side, some marital relationships become closer and more loving. There is a need to carefully observe and consider what is happening, or is likely to happen, to these relationships over time.

Originally posted at InjuryBoard by Bob Carroll

Study May Explain Why Seizures And Memory Defects Often Follow TBI

Bob Carroll — Sat, 21 Oct 2006 02:26:22 GMT

More of the mysteries of traumatic brain injuries are being uncovered by research with every new study. The reason behind the seizures and memory defects often associated with traumatic brain injuries may lie in a reduction in the level of a protein which regulates brain activity.

How Brain Injury Leads To Seizures, Memory Problems

In a finding that may provide a scientific basis for eventual treatment, neurology researchers have shown that traumatic brain injury reduces the level of a protein that helps keep brain activity in balance. The resulting abnormal activity, in turn, is thought to be an underlying reason for seizures and memory defects experienced by people who have suffered a traumatic brain injury (TBI).
"A traumatic brain injury occurs to someone in the United States every 23 seconds," said study team leader Akiva S. Cohen, Ph.D., of The Children's Hospital of Philadelphia, adding that, "TBI is the leading cause of death among children and young adults in this country. There are no cures known for traumatic brain injury. Our hope is that our research may contribute to potential therapies for TBI patients."
Transportation accidents such as car crashes are responsible for the majority of TBIs in people under age 75. According to the National Institutes of Health, over 5 million Americans currently have permanent disabilities resulting from TBIs.

Originally posted at InjuryBoard by Bob Carroll

New Use For Progesterone - Treating Traumatic Brain Injury

Bob Carroll — Mon, 02 Oct 2006 06:04:43 GMT

Doctors have found an unexpected ally in efforts to save people who suffer serious head trauma -- the hormone progesterone. This good news is reported in USA Today.

Progesterone found to help brain trauma

In a study released today, doctors in a small study at Grady Memorial Hospital in Atlanta report giving progesterone, a steroid often associated with pregnancy and sex drives, to patients with serious head injuries.
What they found, according to the study online in the Annals of Emergency Medicine, is that progesterone is safe and that more patients who got progesterone survived moderate head injuries than did those who were given a placebo.
Traumatic brain injuries -- from a gunshot wound to a blow to the head during a football game -- can cause anything from a brief spell of dizziness to coma or death.
In the USA, falls, car crashes and firearms contribute to more than 1 million head injuries each year, according to the Centers for Disease Control and Prevention.
Progesterone has a wide range of uses, from helping women through the first trimester of pregnancy to cutting a pedophile's sex drive. The most common use is as part of hormone-replacement therapy for women after menopause.
Because progesterone receptors are widely distributed in the central nervous system, and because progesterone appears to reduce brain swelling and prevent the loss of some nerve cells in animals studied after brain injury, researchers believe it will help humans with head trauma. Sexual effects wear off hours after the drug is administered.

Originally posted at InjuryBoard by Bob Carroll

What We Can Learn From The Brain Injured

Bob Carroll — Fri, 28 Jul 2006 08:48:06 GMT

For approximately 10 years I attended the meetings and events of a Tampa Bay Head Injury Support Group. My contacts and friendships within the group were very enlightening to me. I learned some surprising things about the capabilities, problems and attitudes of those who are traumatically brain injured.

There are far too many matters to cover in a single article so today I will mention just one insight I gained.

Almost all of the members of the group had a very open and accepting attitude towards their impairment. That is not to say that they were uninterested in treatment or counseling. But, it was surprising at first to see and hear such calm "life goes on" expressions. There was even a fairly high level of humor among the members, some of it self-directed. After a few meetings and events I came to appreciate that this was a group of people who had decided to move on with their lives, to be as happy and fulfilled as possible and to interact with the rest of the world in a positive way.

I wish all of my injured clients could attend these meetings and recognize that no injury should deprive any of us of a meaningful life, even though it may be quite different from what we had planned.

Originally posted at InjuryBoard by Bob Carroll

Poor Care Given To Beating Victim Assumed To Be Drunk

Bob Carroll — Fri, 16 Jun 2006 22:10:30 GMT

The New York Times reports on the terribly deficient emergency services and medical care received by a retired journalist who, after a severe beating, was assumed to be just a drunk lying on a sidewalk. I am not surprised that the assumption of drunkenness impacted the attention given to the victim. Over my years of practice I have noted the same attitude toward other unconscious or semi-conscious persons.

What is different in this news report is that an inspector general conducted a thorough fact-finding mission and issued a report that found fault. If the treatment and medical care of any of my clients were ever investigated by any official or agency (such as the State licensing boards) the facts were hard to see through the whitewash.

Report Cites 'Failures' of Emergency Response in Reporter's Death

Firefighters, ambulance technicians, police officers and the nurses and doctors at a Washington hospital committed "multiple individual failures" in responding to the ultimately fatal beating of a journalist near his home last January, an official inquiry concluded today.
In a report that raised serious questions about emergency medical treatment in the nation's capital, the District of Columbia's inspector general said the initial response to the attack upon David E. Rosenbaum, a retired New York Times reporter, suggested "alarming levels of complacency and indifference."
A string of mistakes led to a collective and erroneous conclusion that Mr. Rosenbaum, who was found lying semi-conscious on a sidewalk the night of Jan. 6, was drunk when in fact he had been beaten and robbed, the inquiry found.
The assumption that Mr. Rosenbaum, 63, was intoxicated led ambulance technicians, police officers and the staff at Howard University Hospital to handle him with far less urgency than is necessary for a person with a head injury, the report said.

Originally posted at InjuryBoard by Bob Carroll

Your Help Needed In Support Of Traumatic Brain Injury Act

Bob Carroll — Fri, 02 Jun 2006 06:05:58 GMT

It's a long letter but an important request for help so here it is in its entirety.

The Brain Injury Association of America needs your help to reauthorize and fully fund the Traumatic Brain Injury Act. Please act on both items before June 7, 2006.

Support the TBI Act of 2006
Congressional Brain Injury Task Force Chairmen, Rep. Bill Pascrell (D-NJ) and Rep. Todd Platts (R-PA) plan to introduce the TBI Act of 2006 in the House of Representatives during the week of June 5. The legislation will reauthorize the TBI Act programs for five more years and will make some important improvements to address emerging issues in brain injury. Your help is needed in recruiting original co-sponsors for the TBI Act in the U.S. House of Representatives. (An original co-sponsor is a Member of Congress who adds his or her name to support
a piece of legislation before it is introduced.)
What to do: Identify your Representative by using the Association's Legislative Action Center.
Contact your Representative and ask that he or she agree to become an original co-sponsor of the TBI Act. If willing, your Representative (or his/her staff member) may contact Charla Penn McManus in Rep. Pascrell's office at (202) 225-5715 or Becky Braunstein in Rep. Platts office at (202) 225-5836.
Your Representative should have already received a copy of the co-sponsor invitation from Congressmen Pascrell and Platts as well as a copy of the proposed legislation. If they haven't received these materials, please offer to forward the information to them. (The documents are available in pdf form from the Brain Injury Association of America's website.
Fully Fund the TBI Act for 2007
On June 7, 2006, the U.S. House of Representative Labor, Health & Human Services, Education and Related Agencies (LHHS) Appropriations Subcommittee will begin work on its appropriations bill. Introduction of the TBI Act of 2006 has been schedule to coincide with the appropriations work.
What to do: Between now and June 7, please contact as many members of the House LHHS Appropriations Subcommittee as possible and request that they support the recommendations of the Congressional Brain Injury Task Force by funding the TBI Act at the following levels:
CDC National Center for Injury Prevention and Control Request - $9 million
HRSA State Grant Program Request - $15 million
HRSA Protection & Advocacy Grant Program Request - $6 million
You can find the Members of the House LHHS Appropriations Subcommittee by going to the this link.
If the Appropriations Subcommittee Members have not seen the Congressional Brain Injury Task Force Appropriations letter, please offer to send them this letter. You can download a copy of the letter from Brain Injury Association of America's web site.
As many of you know, again this year, President Bush recommended elimination of the funding for the TBI State Grant and P&A Grant Programs. It is imperative that Congress hear from the people who are most impacted by these important programs. Please let your voice be heard. Do it today!
On behalf of the Brain Injury Association of America and its nationwide network of state affiliates and the millions of individuals, families and professionals we serve, I thank you for your important work in creating a better future.

Originally posted at InjuryBoard by Bob Carroll