Chronic subdural hematoma Health Article

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 first bleeding.

Alternative Names

Subdural hemorrhage - chronic; Subdural hematoma - chronic; Subdural hygroma

Causes, incidence, and risk factors

A subdural hematoma develops when the tiny veins that run between the dura and surface of the brain (bridging veins) tear and leak blood. This is usually the result of a head injury.

A collection of blood then forms over the surface of the brain. In a chronic subdural collection, blood leaks from the veins slowly over time, or a fast hemorrhage is left to clear up on its own.

A subdural hematoma is more common in the elderly because of normal brain shrinkage that occurs with aging. This shrinkage stretches and weakens the bridging veins. These veins are more likely to break in the elderly, even after a minor head injury. Rarely, a subdural hematoma can occur without known cause (i.e., not from an accident or injury).

Risks include:

• Chronic heavy alcohol use
• Chronic use of aspirin, anti-inflammatory drugs such as Ibuprofen or blood thinning (anti-coagulant) medication
• Diseases associated with blood clotting problems
• Head injury
• Old age

Symptoms

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

Signs and tests

The physical exam will include a full brain and nervous system (neurologic) work-up to test:

• Balance
• Coordination
• Mental functions
• Sensation
• Strength
• Walking

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.