Chronic Subdural Hematoma
Understanding Chronic Subdural Hematoma
A chronic subdural hematoma refers to an accumulation of aged blood and its breakdown products located between the brain’s surface and the outermost protective covering known as the dura mater. This chronic phase typically emerges several weeks after the initial bleeding event.
Causes
A subdural hematoma takes shape when tiny blood vessels, referred to as bridging veins, become damaged and release blood. These veins are responsible for connecting the dura to the brain’s surface and are usually affected by head injuries. The blood accumulates over the brain’s surface. In cases of chronic subdural hematoma, blood either slowly seeps from these veins over time or a rapid hemorrhage resolves on its own.
Chronic subdural hematomas are more frequently observed in older adults due to the natural shrinkage of the brain that occurs with aging. This shrinkage places stress on and weakens the bridging veins, making them more susceptible to rupture in older individuals, even following minor head trauma. It is not uncommon for patients or their families to have no recollection of any injury leading to a subdural hematoma.
Several factors increase the risk of developing chronic subdural hematoma, including:
- Long-term heavy alcohol consumption
- Prolonged usage of medications like aspirin, nonsteroidal anti-inflammatory drugs (e.g., ibuprofen), or anticoagulant drugs such as warfarin
- Medical conditions that impair blood clotting
- Prior head injury
- Advanced age
Symptoms
While some individuals with chronic subdural hematomas may remain asymptomatic, the size and location of the hematoma can lead to various symptoms such as:
- Confusion or coma
- Memory impairment
- Speech and swallowing difficulties
- Gait disturbances
- Drowsiness
- Headaches
- Seizures
- Weakness or numbness in the face, arms, or legs
A thorough medical history will be obtained by your healthcare provider, followed by a comprehensive physical examination. The examination will focus on evaluating brain and nervous system function, assessing factors like balance, coordination, mental acuity, sensory perception, strength, and walking abilities. If a hematoma is suspected, diagnostic imaging tests such as CT or MRI scans will be conducted.
Treatment
The primary objective of treatment for chronic subdural hematoma is symptom management and the prevention of permanent brain damage. Medications may be prescribed to control or prevent seizures.
In some cases, surgery may be necessary. Surgical interventions can involve drilling small holes in the skull to relieve pressure and facilitate the drainage of blood and fluids. For larger hematomas or solid blood clots, a more extensive procedure known as craniotomy, involving a larger skull opening, may be required for removal.
Hematomas that do not cause symptoms may not warrant treatment, as chronic subdural hematomas often reoccur after drainage. In such instances, it may be preferable to leave them untreated unless they produce noticeable symptoms.
Contact Us For An Appointment
The care team at North Carolina Neuroscience & Spine Center can help you decide on the treatment that's best for you. They specialize in minimally invasive surgery and are experienced in diagnosing and treating disorders and diseases, using the newest techniques for relieving pain and returning you to an active lifestyle. To make an appointment at North Carolina Neuroscience & Spine Center call 919-784-7550.
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