Hematoma: Symptoms, Types, Causes and Treatment

Hematomas are a common but potentially serious medical condition characterized by the accumulation of blood outside of blood vessels, typically as a result of injury or bleeding disorders. They can develop anywhere in the body and present with a wide array of symptoms, severities, and risks. Understanding the symptoms, types, causes, and treatment options for hematoma is essential for timely diagnosis and optimal management. This article brings together current research to provide a comprehensive overview of hematoma, offering readers a clear guide to recognizing and managing this condition.

Symptoms of Hematoma

Hematomas can manifest with a wide range of symptoms, depending on their location, size, and underlying cause. Recognizing these symptoms early is crucial, as some hematomas may lead to significant complications if not addressed promptly.

Symptom	Description	Notable Variations	Source(s)
Headache	Persistent or worsening pain in the head	Common in subdural/intracerebral types	1, 7
Neurological	Weakness, confusion, seizures, loss of consciousness	Severity varies by type/location	2, 6, 7
Local Pain	Sharp, intense, or "knife-like" pain	Spinal hematomas often present this way	3, 6
Swelling/Mass	Noticeable lump or swelling	More common in soft tissue hematoma	4, 5

Table 1: Key Symptoms

Recognizing Hematoma Symptoms

Hematoma symptoms vary widely, but certain patterns are notable in specific types and locations.

Headaches and Neurological Changes

• Headache is a hallmark symptom for many cranial hematomas, such as chronic subdural hematoma (CSDH) and intracerebral hematomas. For example, in cases of CSDH, headache is reported in nearly 90% of patients, making it a primary early indicator 1, 7.
• Neurological deficits can range from mild confusion and drowsiness to severe manifestations like seizures, paralysis, or loss of consciousness. These symptoms are especially prominent in subacute and acute subdural hematomas, where rapid worsening is common 2, 7.

Localized Pain

• Spinal hematomas often present with sudden, severe, "knife-like" back pain, which can be followed by numbness, weakness, or paralysis below the level of the hemorrhage 3, 6.
• In soft tissue hematomas, pain is usually localized to the area of trauma or swelling.

Palpable Mass or Swelling

• Hematomas near the skin or within soft tissues may present as a visible or palpable mass. Chronic expanding hematomas, for instance, may mimic tumors due to their slow growth and firmness 4, 5.

Additional Symptoms

• In certain locations, hematomas can cause site-specific symptoms. For example, organized hematomas in the nasal cavity or sinuses may manifest as nasal obstruction or recurrent nosebleeds 5.
• Spinal subarachnoid hematomas may cause symptoms suggestive of meningitis, such as neck stiffness or altered consciousness 6.

Types of Hematoma

Hematomas are classified based on their anatomical location, duration, and pathological characteristics. Each type has distinct clinical implications.

Type	Location/Description	Distinguishing Features	Source(s)
Subdural	Between dura and arachnoid	Acute, subacute, chronic forms	1, 2, 7
Intracerebral	Within brain tissue	Rapid neurological decline possible	8, 10, 11
Spinal	Epidural, subdural, subarachnoid, intramedullary	Severe back pain, paralysis risk	3, 6
Soft Tissue	Muscles, skin, organs	Swelling, mass, possible mimicry of tumors	4, 5

Table 2: Main Hematoma Types

Subdural Hematomas

• Acute Subdural Hematoma: Develops rapidly after head injury; symptoms escalate within hours. High risk of severe neurological deficits and mortality 2.
• Subacute Subdural Hematoma: Symptoms emerge more gradually (over days), but can worsen abruptly, especially in younger individuals. Rapid neurological deterioration is a hallmark; requires urgent attention 2.
• Chronic Subdural Hematoma: Develops slowly over weeks to months, often seen in older adults. Symptoms may be subtle and progress slowly, making diagnosis challenging 1, 7.

Intracerebral Hematoma

• Occurs when bleeding happens within the brain tissue itself. Can rapidly cause loss of consciousness, neurological deficits, and increased intracranial pressure. Often associated with hypertension, vascular abnormalities, or spontaneous vessel rupture 8, 10, 11.

Spinal Hematomas

• Classified by their position relative to the spinal cord and meninges:
  • Epidural: Outside the dura mater—most common.
  • Subdural, Subarachnoid, Intramedullary: Each poses unique risks and symptom profiles, including severe pain and risk of rapid paralysis 3, 6.
• MRI is the diagnostic tool of choice for localization and characterization 3.

Soft Tissue and Organized Hematomas

• Chronic Expanding Hematoma: Slow-growing, may mimic tumors due to persistent expansion and firm texture. Diagnosis often requires imaging and histological analysis 4, 5.
• Organized Hematoma: Often found in the nasal cavity or sinuses, presenting as expansile masses with possible bone remodeling and local invasion. Can simulate malignancy on imaging 5.

Causes of Hematoma

Understanding the underlying causes of hematoma is vital for both prevention and management. While trauma is a leading cause, various other factors can predispose individuals to hematoma formation.

Cause	Description	Associated Types	Source(s)
Trauma	Blunt or penetrating injury	Subdural, intracerebral, soft tissue	7, 2, 8
Anticoagulant Use	Blood-thinning medication	Spinal, subdural, intracerebral	6, 7
Vascular Defects	Malformations or weakened vessels	Intracerebral, spinal	6, 8
Spontaneous/Idiopathic	No clear cause identified	Spinal, subdural (especially elderly)	6, 7

Table 3: Leading Causes of Hematoma

Traumatic Causes

• Head trauma is the predominant cause of subdural and intracerebral hematomas. In younger populations, motor vehicle accidents are most common, while falls are more frequent causes in the elderly 7.
• Soft tissue trauma (e.g., muscle contusions) leads to localized hematomas, presenting as swelling or bruising.

Anticoagulant and Medical Causes

• Use of anticoagulant medications (such as warfarin or heparin) significantly raises the risk of hematoma formation, especially in the spinal cord or brain. Combination with spinal anesthetic procedures increases risk further 6.
• Coagulopathies (bleeding disorders) can predispose patients to spontaneous hematoma formation, often without a clear external trigger.

Vascular Abnormalities

• Aneurysms, arteriovenous malformations (AVMs), or other vascular defects can rupture spontaneously, leading to hematomas in the brain or spinal cord 6, 8.

Spontaneous or Idiopathic Hematomas

• In a significant proportion of spinal and subdural hematomas, no clear cause is identified. This is particularly true in elderly patients, where brain atrophy may stretch bridging veins, making them more susceptible to rupture even with minor or no trauma 6, 7.

Treatment of Hematoma

The management of hematomas depends on their type, location, size, and associated symptoms. Treatment can range from observation to urgent surgical intervention.

Treatment	Approach/Description	Indications/Outcomes	Source(s)
Surgical Evacuation	Burr holes, craniotomy, endoscopic removal	Large, symptomatic, or dangerous hematomas	7, 8, 5
Medical Management	Observation, antifibrinolytics, BP control	Small/early cases, non-surgical candidates	9, 11, 12
Imaging & Monitoring	CT/MRI for diagnosis and follow-up	All hematoma types	3, 4, 5
Supportive Care	ICU admission, rehabilitation, wound care	Severe cases or post-surgery	7, 8, 12

Table 4: Main Treatment Modalities

Surgical Interventions

• Burr Hole and Drainage: The standard for chronic subdural hematoma, especially if symptomatic. It is generally safe and effective, with low recurrence rates 7.
• Craniotomy or Endoscopic Surgery: Reserved for larger, deeper, or more complex hematomas (e.g., intracerebral or organized hematomas in the sinuses). Endoscopic approaches can offer lower mortality and morbidity in selected intracerebral hematoma cases 8, 5.
• Surgical Decompression: Essential for spinal hematomas with neurological deficits. The prognosis is strongly linked to how quickly surgery is performed after onset of symptoms 6.

Medical and Conservative Management

• Tranexamic Acid: An antifibrinolytic drug shown to resolve small or early-stage chronic subdural hematomas, potentially preventing progression and surgical intervention 9.
• Blood Pressure Control: Early, aggressive management of hypertension can limit hematoma expansion in cases of intracerebral hemorrhage 11.
• Observation: Small, asymptomatic hematomas may be observed with serial imaging, provided there is no clinical deterioration 4.

Advanced and Supportive Therapies

• Emerging Therapies: Strategies to enhance hematoma clearance, such as stimulating microglial phagocytosis, have shown promise in animal models of intracerebral hemorrhage 12.
• ICU and Rehabilitation: Patients with severe presentations may require intensive monitoring, wound care, and structured rehabilitation to optimize recovery and functional outcomes 7, 8.

Importance of Prompt Diagnosis

• Imaging: CT and MRI are indispensable for accurate localization, assessment of hematoma age, and surgical planning. Early recognition and intervention are critical for minimizing long-term deficits, especially in spinal and cranial hematomas 3, 4, 5, 6.

Conclusion

Hematomas are complex lesions with diverse symptoms, causes, and management strategies. A thorough understanding of their presentation and prompt, evidence-based intervention can greatly improve outcomes.

• Key takeaways:
  • Symptoms depend on location, ranging from headaches and neurological deficits to localized pain and swelling.
  • Hematomas are classified by location (subdural, intracerebral, spinal, soft tissue) and chronicity.
  • Trauma, anticoagulant use, vascular defects, and spontaneous bleeding are leading causes.
  • Treatment ranges from observation and medical therapy to urgent surgery, depending on severity and type.
  • Early diagnosis and intervention are crucial, particularly for spinal and intracerebral hematomas to prevent permanent deficits.
  • Imaging is essential for diagnosis, while emerging therapies offer hope for improved non-surgical management.

A patient- and evidence-centered approach, informed by the latest research, remains the cornerstone of effective hematoma care.