Your Care Instructions

A subdural hematoma is a buildup of blood between the layers of tissue that cover the brain. The blood collects under the layer closest to the skull. (This layer is called the dura.) The bleeding is most often caused by a head injury, but there can be other causes. In an older adult, even a minor injury can lead to a subdural hematoma.

The buildup of blood inside the skull can put pressure on the brain. This may cause symptoms, such as a severe headache, confusion, or seizures.

There are two kinds of hematomas: acute and chronic.

• With an acute hematoma, symptoms start soon after the injury.
• With a chronic hematoma, it may be days or weeks before symptoms appear.

Doctors use imaging tests to find the buildup of blood. You may have a test such as a CT scan or MRI. The doctor may also do a test to check the pressure inside your skull.

Bleeding inside the skull may get worse over time. So it is very important to pay attention to your symptoms. And be sure to see your doctor for follow-up testing.

In some cases, treatment is needed to remove the blood. This helps relieve the pressure on the brain. Your doctor may make one or two small holes in your skull. For a large hematoma, the doctor may need to remove a piece of the skull.

You may not need treatment if you have a small hematoma that is not causing symptoms.

If you take aspirin or some other blood thinner, you may need to stop taking it. The doctor may give you treatment to undo the effects of the blood thinner. This can help prevent more bleeding in the skull.

The doctor has checked you carefully, but problems can develop later. If you notice any problems or new symptoms, get medical treatment right away.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

For an acute hematoma

• Follow your doctor's instructions. He or she will tell you if you need someone to watch you closely for the next 24 hours or longer.

For a chronic hematoma

• Get plenty of sleep at night, and take it easy during the day. Rest is the best way to recover.
• Avoid activities that are physically or mentally demanding. These include housework, exercise, paperwork, video games, text messaging, and using the computer. You may need to change your work or school schedule for a while.
• Return to your normal activities slowly. Do not try to do too much at once.

For either type of hematoma

• Do not drink alcohol until your doctor says it is okay.
• Don't drive a car, ride a bike, or operate machinery until your doctor says it's okay.
• If you take aspirin or some other blood thinner, be sure to talk to your doctor. He or she will tell you if and when to start taking this medicine again. Make sure that you understand exactly what your doctor wants you to do.
• If you normally take medicine, your doctor will tell you if and when you can restart it. He or she will also give you instructions about taking any new medicines.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

• You have a seizure.
• You passed out (lost consciousness).
• You are confused or can't stay awake.

Call your doctor now or seek immediate medical care if:

• You have new or worse vomiting.
• You feel less alert.
• You have new weakness or numbness in any part of your body.
• You have a headache that is getting worse.

Watch closely for changes in your health, and be sure to contact your doctor if:

• You do not get better as expected.
• You have new symptoms, such as headaches, trouble concentrating, or changes in mood.