Chronic subdural hematoma
Subdural hemorrhage - chronic; Subdural hematoma - chronic; Subdural hygromaA 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.
Chronic
Chronic refers to something that continues over an extended period of time. A chronic condition is usually long-lasting and does not easily or quick...
Read Article Now Book Mark ArticleSubdural hematoma
A subdural hematoma is a collection of blood between the covering of the brain (dura) and the surface of the brain.
Read Article Now Book Mark ArticleCauses
A subdural hematoma develops when bridging veins tear and leak blood. These are the tiny veins that run between the dura and surface of the brain. 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 older adults 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 older adults, even after a minor head injury. You or your family may not remember any injury that might have caused a subdural hematoma.
Risks include:
- Long-term heavy alcohol use
Long-term heavy alcohol use
Alcohol use disorder is when your drinking causes serious problems in your life, yet you keep drinking. You may also need more and more alcohol to f...
Read Article Now Book Mark Article - Long-term use of aspirin, anti-inflammatory medicines such as ibuprofen, or blood thinning (anticoagulant) medicine such as warfarin
- Diseases that lead to reduced blood clotting
- Head injury
- Old age
Symptoms
In some cases, there may be no symptoms. However, depending on the size of the hematoma and where it presses on the brain, any of the following symptoms may occur:
-
Drowsiness, confusion, or coma
Confusion, or coma
Confusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...
Read Article Now Book Mark Article - Decreased memory
- Problem speaking or swallowing
Swallowing
Difficulty with swallowing is the feeling that food or liquid is stuck in the throat or at any point before the food enters the stomach. This proble...
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- Headache
Headache
A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better...
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Seizures
A seizure is the physical changes in behavior that occurs during an episode of specific types of abnormal electrical activity in the brain. The term ...
Read Article Now Book Mark Article - Weakness or numbness of arms, legs, face
- Nausea and vomiting
- Vision problems
Vision problems
There are many types of eye problems and vision disturbances, such as: Halos Blurred vision (the loss of sharpness of vision and the inability to see...
Read Article Now Book Mark Article - Behavioral changes or psychosis
Psychosis
Psychosis occurs when a person loses contact with reality. The person may: Have false beliefs about what is taking place, or who one is (delusions)S...
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Exams and Tests
Your health care provider will ask about your medical history. Your physical exam will include a careful check of your brain and nervous system for problems with:
- Balance
- Coordination
- Mental functions
- Sensation
- Strength
- Walking
If there is any suspicion of a hematoma, an imaging test, such as a CT or MRI scan will be done.
CT
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.
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A head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...
Read Article Now Book Mark ArticleTreatment
The goal of treatment is to control symptoms and reduce or prevent permanent damage to the brain. Medicines may be used to control or prevent seizures.
Surgery may be needed. This may include drilling small holes in the skull to relieve pressure and allow blood and fluids to be drained. Large hematomas or solid blood clots may need to be removed through a larger opening in the skull (craniotomy).
Blood clots
Blood clots are clumps that occur when blood hardens from a liquid to a solid. A blood clot that forms inside one of your veins or arteries is calle...
Read Article Now Book Mark ArticleCraniotomy
Brain surgery is an operation to treat problems in the brain and surrounding structures.
Read Article Now Book Mark ArticleHematomas that do not cause symptoms may not require treatment. Chronic subdural hematomas often come back after being drained. Therefore, it is sometimes better to leave them alone unless they are causing symptoms.
Outlook (Prognosis)
Chronic subdural hematomas that cause symptoms usually do not heal on their own over time. They often require surgery, especially when there are neurologic problems, seizures, or chronic headaches.
Possible Complications
Complications may include:
- Permanent brain damage
- Persistent symptoms, such as anxiety, confusion, difficulty paying attention, dizziness, headache, and memory loss
Anxiety
Stress is a feeling of emotional or physical tension. It can come from any event or thought that makes you feel frustrated, angry, or nervous. Stres...
Read Article Now Book Mark ArticleDizziness
Dizziness is a term that is often used to describe 2 different symptoms: lightheadedness and vertigo. Lightheadedness is a feeling that you might fai...
Read Article Now Book Mark Article - Seizures
When to Contact a Medical Professional
Contact your provider right away if you or a family member has symptoms of chronic subdural hematoma. For example, if you see symptoms of confusion, weakness, or numbness weeks or months after a head injury in an older adult, contact the provider right away.
Take the person to the emergency room or call 911 or the local emergency number if the person:
- Has seizures
- Is not alert (loses consciousness)
Loses consciousness
Decreased alertness is a state of reduced awareness and is often a serious condition. A coma is the most severe state of decreased alertness from whi...
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Prevention
Avoid head injuries by using seat belts, bicycle and motorcycle helmets, and hard hats when appropriate.
References
Kolias AG, Taisic T, Chari A, Hutchinson PJ, Santarius T. Medical and surgical management of chronic subdural hematomas. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 47.
Papa L, Goldberg SA. Head trauma. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 33.
Stippler M, Mahavadi A. Craniocerebral trauma. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 62.
Review Date: 6/13/2024
Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.