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Brain Trauma, Subdural Hematoma and Dementia Pugilistica

Evidence from clinical trials offers fresh hope for those affected by brain trauma.

According to researchers, some instances of brain trauma are reversible if treated in the early stages. New evidence suggests that brain damage does not necessarily happen immediately following a blow to the head. Damage is more likely to result from the subsequent swelling in the brain caused by the formation of a subdural hematoma.

Always seek medical advice following a head injury, however superficial the damage may appear. Your doctor will perform a neurological exam, which may include a brain-imaging scan, to establish the extent of possible brain trauma.

What is a Subdural Hematoma?

A subdural hematoma (also know as a subdural hemorrhage) is a buildup of blood immediately below the dura—the outermost of the three membranes that A normal brain and a brain with a subdural hematoma.

A normal brain and a brain with a subdural hematoma.

surround the brain.

Subdural hematomas occur when the veins located between the surface membrane of the brain and the dura become damaged and bleed, allowing a hematoma—a swelling filled with blood—to form.

Approximately fifteen percent of occurrences of head trauma result in a subdural hematoma.

Causes of Subdural Hematomas

A subdural hematoma is most commonly caused by a severe injury to the head. In instances of acute hematomas, the blood collects quickly, putting pressure on the brain, which may, in turn, result in permanent injury or prove fatal.

Chronic, as opposed to acute, subdural hematomas occur when blood accumulates gradually within the skull cavity over a period of time. A chronic subdural hematoma is often caused by a slight and seemingly insignificant head injury. Chronic subdural hematomas sometimes exhibit symptoms similar to vascular dementia and are particularly prevalent among the elderly.

A subdural hematoma may also occur of its own accord, at any age, without apparent cause with the blood collecting quickly or slowly to form the hematoma.

Symptoms of Subdural Hematomas

Symptoms vary according to the size and nature of the subdural hematoma and its precise location in the brain. Possible symptoms include:

loss of consciousness or coma
lethargy
weakness
delirium
seizures
headaches
vomiting and nausea
memory loss
difficulty concentrating
dizziness
slurred speech
altered mental, intellectual and cognitive capacity
onset of dementia resulting from initial brain trauma.

Infant Subdural Hematomas

Common symptoms of a subdural hematoma in infants include a disproportionate and enlarged head circumference, a swollen fontanel (the soft membrane-covered gap on an infant's head) and disjointed sutures (the junction of bones in the skull).

Risks of Subdural Hematomas

The risks of developing a subdural hematoma include:

head injury, with infants and the elderly at greatest risk
long-term alcohol abuse
use of anticoagulants (blood thinning medications).

Treatments for Subdural Hematomas

Speed is of the essence in the treatment of brain trauma caused by a subdural hematoma, as delay may lead to permanent brain damage.

Emergency treatment for acute subdural hematomas may involve surgery to reduce the pressure on the brain. This procedure entails an incision in the skull to allow the blood to drain. In cases where large subdural hematomas or solid blood clots have formed, major surgery may be required to remove the hematomas.

Subdural Hematoma Medication

The type of medication prescribed depends on the severity of the symptoms and on the extent of brain trauma. Common medications for the treatment of a subdural hematoma include anticonvulsants to prevent seizure and diuretics to control swelling.

Prognosis for Subdural Hematoma Brain Trauma

The prognosis for chronic subdural hematomas is generally good for patients who receive early diagnosis and treatment. The outcome for acute subdural hematomas tends to be less favorable, particularly in cases of acute brain trauma.

Several factors play an important part in determining the prognosis for subdural hematomas, including:

the type and location of the head injury
the extent of brain trauma
the size of the subdural hematoma
whether the patient received emergency treatment for a subdural hematoma.

Expert opinion is divided as to whether the removal of a subdural hematoma results in patients regaining their full mental capabilities. Researchers continue their efforts to determine whether the damage caused by the persistent pressure of a subdural hematoma on the brain is treatable.

New Treatment Guidelines For Brain Trauma
Encouraging findings documented by the Brain Trauma Foundation (BTF) suggest that if secondary brain trauma is treated using new scientific guidelines, around 20,000 lives could be saved each year in the US.

Dementia Pugilistica

Dementia pugilistica is a neurological disorder caused by repeated blows to the head, resulting in brain trauma.

Boxers, in particular, are prone to the type of sustained head trauma associated with dementia pugilistica.

Among members of the boxing profession, the onset of dementia pugilistica occurs on average at around sixteen years following initial exposure to repetitive head trauma.

The symptoms of dementia pugilistica include dementia, characterized by loss of cognitive function, and Parkinson's disease, a neurological disorder characterized by tremor and muscular rigidity.

Dementia pugilistica is also known as: