A chronic subdural hematoma is a slow buildup of blood between the brain and the membrane that covers it, known as the dura. This most commonly occurs as a result of a mild head injury that occurred at some time in the past; in fact, often the individual does not remember a specific episode of trauma.
Chronic subdural hematoma occurs when bridging veins connecting the larger venous sinuses with the surface of the brain rupture, slowly leaking blood into the subdural space.
With age, the brain shrinks, increasing the space between the brain and the skull, thus putting more traction on these bridging veins. This explains why chronic subdural hematoma is a disease of the elderly. Over time, the hematoma can enlarge. This puts pressure on the brain and produces symptoms described below.
Symptoms of a chronic subdural hematoma can be subtle and may not be recognized for weeks to months after the injury. The most common symptoms include: drowsinesscognitive dysfunction (difficulty and errors in the thought process)poor attention span
Other symptoms include: headaches that get worse over timenausea and vomitingseizuresunequal size of the pupils of the eyesvision changes such as blurred visionweakness on one side of the body, known as hemiparesis
Chronic subdural hematoma occurs in the elderly often because of a head injury sustained at some time in the past which may or may not have been recognized. Other risks include the use of warfarin (Coumadin), a medication that interferes with blood clotting. Conditions that inhibit blood clotting such as liver disease, alcoholism, and malnutrition may also be responsible for the hematoma.
Prevention of chronic subdural hematoma requires protecting the head from injury. One way to do this is to use seat belts when in a car and avoid situations that may lead to an unintentional fall. Frequent monitoring of blood coagulation while on warfarin will help to alleviate the risk of bleeding.
Diagnosis of a chronic subdural hematoma begins with a complete medical history and physical exam. The healthcare professional may order tests, such as a cranial CT scan. A cranial MRI or cerebral angiogram can also show hematomas.
Chronic subdural hematoma can result in severe physical, emotional, and cognitive impairments, particularly if the symptoms are not recognized before the brain is compressed and damaged by the hematoma. However, if the hematoma is diagnosed and treated early and appropriately, there may be little or no long term impairment.
A chronic subdural hematoma poses no risk to others.
Once the chronic subdural hematoma is located, a neurosurgeon may recommend surgery to remove the clot. If there is impairment from this condition, the person may need long-term rehabilitation. Long-term treatment involves joining a brain injury program and working with a team of specialists such as: occupational therapistsphysical therapistsphysiciansa neuropsychologist
These specialists can help the person to learn new coping strategies. Long-term treatment can continue for several years depending on the severity of symptoms.
After surgery to remove the hematoma, some people may suffer from permanent brain damage in the area under the hematoma. This damage may affect motor skills and the ability to carry out normal, daily activities. Seizures can also develop.
Long term rehabilitation may be required if physical and mental impairment is significant. If seizures develop, medicine will be needed to control them.
The healthcare professional may recommend periodic visits to watch for any return of symptoms. Any new or worsening symptoms should also be reported.
