Subdural hematoma - chronic

Alternative names 
Subdural hemorrhage - chronic; Chronic subdural hematoma

Definition
A chronic subdural hematoma is an “old” collection of blood and blood breakdown products between the surface of the brain and its outermost covering (the dura). The chronic phase of a subdural hematoma begins several weeks after the initial bleeding.

Causes, incidence, and risk factors

Tiny veins called bridging veins run between the dura and the surface of the brain. A subdural hematoma develops when these veins tear and leak blood, usually as the result of a Head injury. A collection of blood then forms over the surface of the brain. In a chronic subdural collection, the problem is not discovered immediately and blood leaks from the veins slowly over time.

A subdural hematoma is more common in the elderly because normal brain shrinkage occurs with aging that stretches and weakens the bridging veins. Thus, these veins are more likely to break in the elderly, even after a minor Head injury. Rarely, a subdural hematoma can occur spontaneously (i.e., not from an accident or injury).

Risks include Head injury, old age, chronic use of aspirin, anti-inflammatory drugs such as Ibuprofen or blood thinning (anti-coagulant) medication, chronic heavy alcohol use, or many diseases associated with blood clotting problems.

Symptoms

     
  • Headache  
  • Confusion or coma  
  • Decreased memory  
  • Seizures  
  • Weakness or numbness of arms, legs, face  
  • Difficulty speaking or swallowing  
  • Difficulty walking

Signs and tests

The physical exam will include a full neurologic work-up to test mental functions, strength, sensation, coordination, walking, and balance. Because the symptoms and signs are often subtle, if there is any suspicion of a hematoma, a head CT or head MRI will most likely be done to further evaluate the problem.

Treatment

The goal is to control symptoms and minimize or prevent permanent damage to the brain. Corticosteroid medications may be used to reduce any swelling of the brain. Anticonvulsant medications, such as phenytoin, may be used to control or prevent seizures.

Surgery is often required. This may include drilling small holes in the skull to relieve pressure and allow blood to be drained. Large hematomas or solid blood clots may need to be removed through a larger opening in the skull (craniotomy).

Expectations (prognosis)

Few chronic subdural hematomas heal themselves over time. They often require neurosurgery, particularly in the case of significant brain displacement, neurologic problems, seizures, or chronic headaches. Some chronic subdural hematomas return after drainage, and a second surgery may be necessary.

Complications

     
  • Permanent brain damage  
  • Persistent symptoms       o Loss of memory       o Dizziness       o Headache       o Anxiety       o Difficulty maintaining attention  
  • Seizures

Calling your health care provider

Because of the risk of permanent brain damage, call a health care provider promptly if you or someone else develops symptoms of chronic subdural hematoma.

Take the person to the emergency room or call 911 if the person has convulsions/seizures, isn’t responsive, or loses consciousness.

Prevention

Avoid head injuries by using seat belts, bicycle and motorcycle helmets, and hard hats when appropriate.

Johns Hopkins patient information

Last revised: December 5, 2012
by David A. Scott, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.