Subdural Haemorrhage Complaint - Queensland Solicitors QLD

LAWYER HELPLINE: 07 3613 7325

If you think that you have received inadequate or negligent medical treatment for subdural haemorrhage, our solicitors will be able to assist you in making a complaint to the Office of the Health Ombudsman (OHO) in Queensland. Our QLD based solicitors deal with health care complaints on a ‘pro bono’ basis and will not make any charge to you for advice on how to make a complaint to the Office of the Health Ombudsman. A complaint to the Office of the Health Ombudsman in QLD is not a medical negligence compensation claim and will not result in the payment of compensation but may assist you in further understanding what went wrong and why you were treated in the way that has caused you concern. There are a number of possible outcomes and the Queensland Office of the Health Ombudsman may be able to obtain a more full explanation of the circumstances of any alleged negligence or may give you more details about the treatment that you have received.

Subdural Haemorrhage

A subdural haemorrhage leads to a subdural haematoma, which is bleeding between the dura mater and the brain. The main cause of a subdural haematoma is a traumatic brain injury and results from tearing of the bridging veins that cross the subdural space. Bridging vein bleeding means that the condition is a venous bleed that is far slower than the rate of bleeding in the subarachnoid haemorrhage. The biggest problem with a subdural haemorrhage is that it fills up space otherwise occupied by the brain; the pressure builds up and pushes part of the brain into the hole at the base of the brain and the person suffers a fatal cardiac arrest.

Subdural haemorrhage can be acute or chronic. Chronic SDH is not as life threatening as acute SDH; they are common in older adults who fall and don’t realize they could have a bleed inside the brain. SDH are contrasted by epidural haematomas, which are arterial bleeds between the dura mater and the skull. Acute SDHs are the most dangerous and lethal of all types of head injuries, with a high mortality rate if they are not promptly surgically treated.

Acute SDHs happen after high speed injuries involving a quick deceleration or acceleration such as in a car accident. If the hematoma is large, this has a worse prognosis than small ones. SDHs, acute, that are associated with cerebral contusions have the worst prognosis, even higher than epidural haematomas because the pressure can rapidly build up in the brain, leading to brain herniation. The mortality rate of SDH is between 60 and 80 percent.

Chronic SDHs develop over a span of several days to weeks and usually represent a mild head injury. Half of all injured patients can’t recall what injury happened to them. It may take months to years to diagnose. The bleeding usually stops by itself and can usually be stopped before major damage to the brain can occur. Small bleeds are less injurious with only 22 percent having a recovery outcome worse than good. The elderly make up the bulk of these injuries.

Signs and symptoms of a SDH are generally less than those of an epidural haematoma because the onset of bleeding is slower. Subacute haematomas can take up to two weeks to develop. Diagnosis of SDH sometimes isn’t made until there is an increased intracranial pressure or if there is damage to the underlying brain.

Common signs and symptoms of SDH include the following things:

  • History of a recent head trauma
  • Irritability
  • A brief loss of consciousness or fluctuating level of consciousness
  • Headache pain
  • Seizures
  • Dizziness
  • Numbness
  • Retrograde amnesia
  • Disorientation
  • Lethargy
  • Weakness
  • Loss of appetite
  • Nausea and vomiting
  • Changes in personality
  • Difficulty walking
  • Unusual breathing patterns
  • Loss of muscle control
  • Loss of hearing
  • Ringing in the ears
  • Eye abnormalities
  • Blurry vision

The biggest cause of SDH is head trauma in which there are rapidly changing velocities, such as a car accident. This tears the bridging veins atop the brain. SDHs are more likely due to head injury than is the case with epidural hematomas, which are more likely secondary to aneurysms. SDHs are more common than epidural haematomas and are caused by shearing injuries. A subdural haematoma is the finding most often seen in shaken baby syndrome, which also results from shear injuries. It is also commonly seen in alcoholics, who fall all the time and have previous evidence of cerebral atrophy. Cerebral atrophy increases the length of the bridging veins and causes an increased chance of them rupturing. If a person is on anticoagulants like warfarin or aspirin, they have a higher incidence of bleeding even with minor trauma.

Risk factors for subdural haematoma include being very young or very old. The brain shrinks with age so that the subdural space gets bigger. It results in lengthening of the bridging veins which stand a greater chance of breaking. The elderly also have more brittle veins, which break more easily. Infants also have larger subdural spaces so they are especially at risk for SDH. In children, having an arachnoid cyst makes it more likely to have a subdural haematoma. Other risk factors include alcohol abuse, having dementia and being on anticoagulants.

When the bridging veins bleed, the blood within the bleed draws in extra water so the bleed expands and tears new blood vessels leading to further bleeding. The collected blood can over time develop its own membrane and be encased in it. Substances that result in vasoconstriction can be released in a SDH. This causes ischemia in surrounding brain areas. This causes what is known as the ischemic cascade that can cause brain cell death. Eventually the body will absorb the clot so that granulation tissue can take its place.

In diagnosing subdural haematoma, the patient receives a thorough neurological and medical exam. Then a CT scan of the head or an MRI exam of the head is performed which can show the bleeding area. Subdural hematomas are often seen on the tops or the sides of the parietal and frontal lobes along with the back of the head. SDH can grow along the entire inside of the skull, following the curve of the brain. They cannot, however, spread past the center point of the brain. Their shape is usually concave but can be convex if the bleed is new. Doctors can tell that a bleed is subdural because it tends to be concave and can cross suture lines, whereas the epidural bleed cannot cross a suture line. This means that SDH tend to be bigger.

Treatment of a subdural haematoma can involve careful monitoring if it is small and growing slowly. A hole can be placed in the skull with a cannula that reduces the size of the bleed and the pressure on the brain. Very symptomatic haematomas need an open craniotomy and drainage of the hematoma. Bleeding spots are controlled at the time of surgery and the skull is replaced. Doctors look later for signs of increased intracranial pressure, renewed bleeding, and edema of the brain. Infection is a possibility any time there is surgical opening of the skull.

LAWYER HELPLINE: 07 3613 7325