A subdural hematoma is a dangerous accumulation of blood between the brain’s surface and its outer covering (dura), usually caused by traumatic tearing of blood vessels. It requires emergency surgery (craniotomy or burr hole) when it creates high intracranial pressure, resulting in rapid deterioration, severe headaches, confusion, or severe neurological deficits
According to Dr. Gurneet Singh Sawhney, neurosurgeon in Mumbai,
“subdural hematomas are missed constantly in elderly patients because the head injury seemed minor. By the time confusion sets in, the clot is already large enough to cause serious brain shift.”
What Are the Types and How Do They Present
Presentation varies enough that the same diagnosis looks completely different in two patients.
- Acute subdural hematoma: Develops within 72 hours of trauma. High-velocity injury usually. Car accident, fall from height. Patient deteriorates fast. GCS drops. Pupil changes. This is the one that kills within hours if surgery is delayed. No time for extended observation.
- Subacute subdural hematoma: Three days to three weeks post-injury. Slower deterioration. The headache gets progressively worse. Confusion develops. Sometimes gets misread as stroke or dementia in older patients. Delay in diagnosis is common and consequential.
- Chronic subdural hematoma: Weeks to months after a minor head injury. Common in elderly, anticoagulant users, alcoholics. The original fall was so minor it wasn’t mentioned. Blood liquefies over time and the collection grows. Fluctuating confusion, one-sided weakness, speech changes. Often misattributed to aging until a scan is finally done.
- Spontaneous subdural hematoma: No trauma at all. Happens in patients on anticoagulants or with coagulation disorders. Dural metastases occasionally. Rarer but important not to miss in patients presenting without a clear injury history.
Patients already looking at brain tumor surgery in Mumbai sometimes arrive having already read about whether neurological problems can exist with normal scans. CT is the first scan here. MRI adds detail but CT shows the blood fast.
When Does a Subdural Hematoma Need Emergency Surgery
Not every subdural needs an operation. But the ones that do can’t wait.
- Clot thickness and midline shift: Clot over 10mm thick on CT or midline shift over 5mm on imaging. These are the standard surgical thresholds. Brain is being compressed. Herniation risk is real. Surgery within hours not days.
- GCS of 8 or below: Patient is no longer protecting airway adequately. Neurological deterioration is active. Waiting for more imaging or second opinions at this point causes preventable death and disability.
- Pupil changes: Unequal pupils, fixed dilated pupil on one side. Uncal herniation happening in real time. This is a neurosurgical emergency. Theatre immediately.
- Deteriorating despite conservative management: GCS was 12 on admission, now 9. Clot not large enough to meet imaging criteria but patient is actively worsening. Clinical picture overrides the numbers. Surgery.
Small chronic subdurals in alert patients sometimes get managed with corticosteroids or observation. But the moment neurological status drops or clot grows on repeat imaging, surgery becomes the answer.
As a Neurosurgeon in Mumbai managing acute neurosurgical emergencies at Fortis Hospital Mulund West, Dr. Sawhney’s assessment combines clinical status, imaging findings, and trajectory not imaging thresholds alone.
Why Choose Dr. Gurneet Singh Sawhney
Dr. Gurneet Singh Sawhney trained in functional neurosurgery under Prof. Taira at Tokyo Women’s Medical University and epilepsy surgery under Prof. Sugano at Juntendo University. Two dedicated subspecialty fellowships at high-volume centres. At Fortis Hospital Mulund West, emergency neurosurgical cases get CT review, clinical assessment, and surgical decision within the window that changes outcomes. Not after it.
Families arrive after being told a fall was minor and a scan wasn’t needed. Some of them are right. Some of them aren’t and the difference shows up two weeks later. Getting the right imaging early is cheaper than emergency surgery late. Call +91 8104310753 to book your consultation.
FAQ’s
What is a subdural hematoma?
Blood collecting between the brain surface and dura, usually from torn bridging veins after head trauma.
What is the difference between acute and chronic subdural hematoma?
Acute develops within 72 hours of injury and deteriorates fast; chronic builds slowly over weeks often after a minor fall.
What are the surgical thresholds for subdural hematoma?
Clot thickness over 10mm, midline shift over 5mm, GCS of 8 or below, or active neurological deterioration despite observation.
Can a subdural hematoma be treated without surgery?
Small chronic subdurals in alert stable patients can be observed or managed with steroids, but any deterioration makes surgery the answer.
References
- National Institute of Neurological Disorders and Stroke. Neurological Diagnostic Tests and Procedures. NINDS, NIH.
- Brennan PM, et al. Acute Subdural Haematoma. PubMed Central, NCBI.