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My Husband Has A 4 Mm Subdural Hematoma Is It More Likely That He Will Have To Go To Surgery?
Posted on
Sun, 29 Jul 2018
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Sun, 29 Jul 2018
Answered on
Wed, 21 Dec 2022
Last reviewed on
Question : Dr. Taka,
My husband has a 4 mm subdural hematoma from a horse fall (or a later incident on exercise equipment..which aren't quite sure what caused it). The neuro surgeon says we just need to keep watching it. So two weeks later follow up scans show no change. Thankfully, the symptoms have stopped (numbness going up to his throat & affecting speech). How long is the typical time period for a 4 mm to be absorbed by the body? Is it likely this will happen or is it more likely that he will have to go to surgery and have it drained? Like, for example if there is no change (it remains at 4 mm) he can't exactly get on with his life with a chronic bleed, either? Another dr. said it could take months to go away, and another one said 6-8 weeks. You have answered me in the past and been very thorough in your responses so I prefer to listen to you right now.
My husband has a 4 mm subdural hematoma from a horse fall (or a later incident on exercise equipment..which aren't quite sure what caused it). The neuro surgeon says we just need to keep watching it. So two weeks later follow up scans show no change. Thankfully, the symptoms have stopped (numbness going up to his throat & affecting speech). How long is the typical time period for a 4 mm to be absorbed by the body? Is it likely this will happen or is it more likely that he will have to go to surgery and have it drained? Like, for example if there is no change (it remains at 4 mm) he can't exactly get on with his life with a chronic bleed, either? Another dr. said it could take months to go away, and another one said 6-8 weeks. You have answered me in the past and been very thorough in your responses so I prefer to listen to you right now.
Brief Answer:
About two months.
Detailed Answer:
Hello and thank you for your nice words and the trust you've put in me, I appreciate it.
Usually the time needed for blood to break down and to eventually be absorbed is about 2 months (so the 6-8 weeks is perhaps the more accurate estimate). However, at times due to the inflammatory response in the area, with new fragile capillaries formed, there may continue to be fluid and blood leaks developing into a chronic subdural hematoma which may persist for month depending on the balance between fluid and blood formation and absorption. So in some cases it may be a matter of as many as 6 months, that answer may apply as well. Given the fact that the blood layer is very thin at 4 mm I would say that while not a certainty there is reason to be optimistic that it will be absorbed inside two months though.
Even in the case that there is persistence of fluid though, it doesn’t mean that it will need to be drained. If there are no deterioration symptoms and size remains at 4 mm surgery is not indicated, neither at this acute stage nor at a chronic one.
So at this stage patience is needed as it may take some time to get definitive answers. What should matter now is that while the thickness may remain at 4 mm for some time, there is no imaging evidence of new blood (blood looks different depending on its age). As long as that is not the case you have every reason to be hopeful for a complete resolution of the hematoma in time.
I remain at your disposal for other questions.
Thanks.
About two months.
Detailed Answer:
Hello and thank you for your nice words and the trust you've put in me, I appreciate it.
Usually the time needed for blood to break down and to eventually be absorbed is about 2 months (so the 6-8 weeks is perhaps the more accurate estimate). However, at times due to the inflammatory response in the area, with new fragile capillaries formed, there may continue to be fluid and blood leaks developing into a chronic subdural hematoma which may persist for month depending on the balance between fluid and blood formation and absorption. So in some cases it may be a matter of as many as 6 months, that answer may apply as well. Given the fact that the blood layer is very thin at 4 mm I would say that while not a certainty there is reason to be optimistic that it will be absorbed inside two months though.
Even in the case that there is persistence of fluid though, it doesn’t mean that it will need to be drained. If there are no deterioration symptoms and size remains at 4 mm surgery is not indicated, neither at this acute stage nor at a chronic one.
So at this stage patience is needed as it may take some time to get definitive answers. What should matter now is that while the thickness may remain at 4 mm for some time, there is no imaging evidence of new blood (blood looks different depending on its age). As long as that is not the case you have every reason to be hopeful for a complete resolution of the hematoma in time.
I remain at your disposal for other questions.
Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much. We may have follow up questions but this gives us a great base if information! We are feeling better about things because we are better informed.
Brief Answer:
I hope things get better soon.
Detailed Answer:
You are welcome. I hope things work out for the best. Let me know if I can further assist you.
Regards.
I hope things get better soon.
Detailed Answer:
You are welcome. I hope things work out for the best. Let me know if I can further assist you.
Regards.
Above answer was peer-reviewed by :
Dr. Remy Koshy
We do have another question. It seems odd to us that the bleed didn't show up on the first ct scan within a few days of the fall off a horse which occurred on XXXXXXX 11. He was having headaches though around july 4, and just super tired. On July 12, though, he got on one of the vibrating pad devices at an exercise equipment store, and the vibrating was unbelievable...it definitely shook his head.
I was wondering if possibly the fall from the horse weakened an area in his head, and then getting on the machine caused the full-on bleed. Because my husband ended up in the hospital within 72 hours of getting on that machine. We're just trying to figure it out...and you see, the first scan, after the fall of the horse, showed nothing and so he thought he was in the clear to do whatever he wanted.
I was wondering if possibly the fall from the horse weakened an area in his head, and then getting on the machine caused the full-on bleed. Because my husband ended up in the hospital within 72 hours of getting on that machine. We're just trying to figure it out...and you see, the first scan, after the fall of the horse, showed nothing and so he thought he was in the clear to do whatever he wanted.
Brief Answer:
Read below
Detailed Answer:
Hello again!
Of course it is hard to give a certain answer to your question. My hypothesis would be that there was indeed a teared vein after the horse fall but the clotting was effective and there wasn’t any significant blood leak, not enough to be seen on the CT scan. That intense vibration later on may have caused that teared vein to reopen and bleed some more reaching that 4 mm thickness you describe.
Another possibility would be that after an initial small leak, undetected by the CT, there was inflammation and the development of fragile capillaries in the area in the following weeks (the mechanism of a chronic hematoma formation I explained in my first answer). That vibrating may have triggered some more leaking from these fragile capillaries.
The headaches and the tiredness you describe would more probably be due to a concussion from the fall rather than from that small quantity of blood directly. Concussion with a normal CT may cause headaches and that tiredness you describe which may persist for weeks or even months at times.
I hope to have been of help.
Thanks.
Read below
Detailed Answer:
Hello again!
Of course it is hard to give a certain answer to your question. My hypothesis would be that there was indeed a teared vein after the horse fall but the clotting was effective and there wasn’t any significant blood leak, not enough to be seen on the CT scan. That intense vibration later on may have caused that teared vein to reopen and bleed some more reaching that 4 mm thickness you describe.
Another possibility would be that after an initial small leak, undetected by the CT, there was inflammation and the development of fragile capillaries in the area in the following weeks (the mechanism of a chronic hematoma formation I explained in my first answer). That vibrating may have triggered some more leaking from these fragile capillaries.
The headaches and the tiredness you describe would more probably be due to a concussion from the fall rather than from that small quantity of blood directly. Concussion with a normal CT may cause headaches and that tiredness you describe which may persist for weeks or even months at times.
I hope to have been of help.
Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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