Bleeding in the brain, namely a subdural hematoma, can result from getting hit in the head or hitting your head in a fall.

“Traumatic brain injury (TBI) can produce hemorrhages (including subdural, epidural and subarachnoid) from the focal trauma to a particular area of the brain,” says D’Wan Carpenter, DO, a board certified physical medicine and rehabilitation physician with SIMEDHealth in FLA.

“In the case of subdural hematoma (SDH), the traumatic force causes shearing of the bridging veins which lie between the pia-arachnoid layer and the dura.

“There is an increased risk of subdural occurring from concussion/mild TBI in people with cerebral atrophy (generalized loss of brain parenchyma), a normal finding in the elderly.”

This is because there’s more room or space between the veins and the skull for them to be torn, whereas, in young people, this space is very tight (due to a bigger brain).

Younger people are far more likely to sustain an acute subdural hematoma — typically from vehicular crashes and sport-related impact (skiing, boxing, football).

“The findings of a SDH can occur immediately [acute], between three days and three weeks [sub-acute] or greater than three weeks [chronic],” says Dr. Carpenter.

“This is in part due to the fact that the blood flow through the bridging veins is at a low pressure.

“And this [sometimes] creates a slow leak of blood into the space between the skull and the dura mater.

“The severity of the TBI is typically related to the rate blood accumulates.”

An acute subdural hematoma is an emergency situation and has an 80 percent mortality rate.

Credit: myupchar/wikimedia commons

With a chronic subdural hematoma the patient can go weeks, even a few months, before symptoms begin appearing.

This happened to my mother: Six weeks after fainting and then falling, hitting her head on the ceramic bathtub — she experienced her first symptoms.

One was weakness in a leg and a difference in the way she walked as a result.  

She also experienced a major, persistent headache that she described as a “crown of thorns.”

Have a question about brain bleeds?  

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Dr. Carpenter is one of the nation’s top board-certified physical medicine and rehabilitation physicians, a national speaker, medical legal expert and independent medical examiner. She is founder and Chief Medical Officer of DJC Physical Medicine Consultants. Follow Dr. D’Wan on Twitter.
Lorra Garrick is a former personal trainer certified through the American Council on Exercise. At Bally Total Fitness she trained women and men of all ages for fat loss, muscle building, fitness and improved health. 


Top image credit: Lucien Monfils