The dura mater is the brain’s personal bodyguard. Tough, fibrous, and uncomplaining, it lines the inside of the skull like the protective cover of a treasured book. It doesn’t get much limelight, but when something threatens it, the consequences can be swift and unforgiving.
In Latin, dura mater means ‘tough mother’, which feels entirely appropriate—it shields, endures, and doesn’t complain. Until it has to.
One rainy night, a call came from the emergency department: A 48-year-old man, Kailash, had been found unconscious at home. His wife said he’d slipped in the bathroom that morning but insisted he had been fine after that. He had gone about his day, eaten lunch, taken a nap—and then he hadn’t woken up.
By the time he reached us, his right pupil was larger than the left, and his breathing had that irregular rhythm that makes one move faster without thinking. A quick CT scan told the story: There was a large acute subdural hematoma, blood trapped between the dura and the brain, compressing it mercilessly to one side—like a crowd boarding a local at Dadar station. There’s a quiet dread that comes with seeing one side of the body fail to keep up with the other, a signal that the brain is running out of space and time.
Here’s the thing about the dura: It doesn’t tear easily. Its leathery raincoat is built for bad weather days. But when a bridging vein between the dura and brain snaps, blood has nowhere to go but into this tight, unforgiving space. The skull can’t expand. Pressure rises. Brain tissue shifts. And the clock starts ticking. I’ve always thought of the dura as the bouncer outside a club—polite when things are calm, but ready to flex when there’s trouble. In this case, the trouble was enough to get us rushing Kailash to the operating theatre.
The drill met the skull with that familiar high-pitched whine, sending up fine bone dust—the surgical equivalent of sawdust in a carpenter’s workshop, except the stakes were higher and the deadline shorter. When we lifted the bone flap, the dura stared back—tense, stretched, and with a bluish tint that betrayed the clot beneath. I made a cruciate (cross-shaped) incision with the scalpel. The dura, usually dry and reserved, parted to release a thick, dark clot. It oozed out in layers, each one like the filling of an extremely generous pastry, except here, the excess was life-threatening. Every scoop with the suction catheter lightened the brain’s load. Bit by bit, the compressed hemisphere began to breathe again—pink, glistening, and no longer straining against its confines. Once the last remnants of the clot were out, we irrigated the subdural space with warm saline. The brain relaxed into its natural shape, like a hand unclenching after holding on too tightly. We inspected the surface for bleeding points, sealed what we found, and stitched the dura closed. The bone flap went back, snug as a lid on a well-packed dabba.
People imagine brain injuries are dramatic at the scene—lots of screaming, blood, the loud wail of an ambulance. More often, though, they are deceptively quiet. A knock on the head, a “I’m fine”, a nap that lasts too long. Subdural hematomas can whisper for hours before they roar. And when they roar, you have minutes to answer. If there’s one thing the dura has taught me, it’s this: Protect it, respect it, and never ignore the slow, subtle signs of trouble after a head injury.
Kailash woke up two days later, confused but alive. He asked his wife why the ceiling fan looked different. She burst into tears—the good kind. By the end of the week, he was walking with a little help. On discharge, he shook my hand and said, “Doc, my wife tells me you took a piece of my head off.” “Only temporarily,” I said. “It’s back where it belongs!”He grinned. “Then I guess I’m a man who can say he’s been out of his mind… and has come back in again.”
The author is consultant neurosurgeon at Wockhardt Hospital, Mumbai.
mazdaturel@gmail.com, Instagram@mazdaturel