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Causes of chronic subdural hematoma

Chronic subdural hematoma is a well-known and relatively frequent case in the elderly (particularly those above 60 years old) because they have a larger subarachnoid space than young adults. The larger subarachnoid space due to cortical atrophy allows for more movement between the brain and dura, predisposing them to the formation of subdural hematomas. Even a relatively mild trauma can provoke subdural veins to rupture and leak blood. Chronic subdural hematoma can also be spontaneous (without association to brain trauma), such as in the case of patients taking anticoagulant medication (blood thinners, including aspirin), chronic use of alcohol and disease-related blood clotting problems.

Signs and symptoms of chronic subdural hematoma

Signs and symptoms of a chronic subdural hematoma can be subtle and may not be recognized for weeks to months after the onset. The most common symptoms include:

• Drowsiness
• Cognitive dysfunction that manifests in episodes of confusion and slow-thinking
• Lethargy
• Enlarged or asymmetric pupils
• Convulsions
• Poor attention span
• Personality changes
• Headaches (may come and go and get worse over time )
• Mild paralysis
• Weakness on one side of the body, known as hemiparesis
• Brief episodes of extensive paralysis
• Brief episodes of speaking difficulties
• Seizures
• Nausea and vomiting
• Vision changes such as blurred vision

Treatment of chronic subdural hematoma

As with other types of subdural hematoma, treatment of a chronic subdural hematoma is aimed to control symptoms and minimize or prevent permanent damage to the brain. Diuretics and corticosteroid medications are usually used to reduce swelling of the brain. Anticonvulsant medications, such as phenytoin, may be used to control or prevent seizures.

Surgery is often required. Different from the surgical procedure for acute subdural hematomas– where craniotomy becomes a standard routine– the prevalent treatment of chronic subdural hematomas is burr hole surgery in the skull to relieve pressure and allow blood to be drained. It provides equivalent efficacy at lower morbidity and mortality. This surgery can be performed either under local or general anesthesia.

Prognosis of chronic subdural hematoma

Different from acute subdural hematoma where only about 50% of patients who are treated for a large hematoma survive, patients who are treated for a chronic subdural hematoma usually improve or do not worsen. However, permanent brain impairment may occur if the treatment is late.