Chronic Subdural Hematoma

Overview, Causes, & Risk Factors

A chronic subdural hematoma is a buildup of bloodbetween the brain and the membrane that covers it, known as thedura. This condition occurs as a result of ahead injuryand develops slowly over time. The trauma does not have to beserious to produce this condition.

What is going on in the body?

A chronic subdural hematoma begins when a veinruptures. This causes slow bleeding into the space between thedura and the brain. Over time, the hematoma can enlarge. Thisputs pressure on the brain and produces mild to severe symptoms.

What are the causes and risks of the condition?

A chronic subdural hematoma is often caused by adirect blow to the head, such as hitting the head on a rock. Itcan also occur as a result of an indirect blow, such as when aninfant is shaken violently. This causes shaken baby syndrome.During an indirect blow, the brain moves forcefully back and forth,hitting the inside of the skull.

Risk factors for chronic subdural hematoma include:

  • being elderly, a group at high risk for falls
  • child abuse
  • chronic conditions such as diabetes,epilepsy,or alcoholism
  • Symptoms & Signs

    What are the signs and symptoms of the condition?

    Symptoms of a chronic subdural hematoma can be hardto notice. They may not develop for weeks to months after the firstinjury. The most common symptoms include:

  • a gradual change in alertness
  • less ability to use advanced thinking skills, such asthose used in processing new information, making decisions,and following complex instructions
  • poor attention span
  • Other symptoms include:

  • headachesthat get worse over time
  • nauseaand vomiting
  • seizures
  • unequal pupils of the eyes
  • vision changessuch as blurred vision
  • weaknesson one side of the body, known as hemiparesis
  • Diagnosis & Tests

    How is the condition diagnosed?

    Diagnosis of a chronic subdural hematoma begins witha complete medical history and physical exam. The doctormay order tests, such as acranial CT scan.A cranial MRIor cerebral angiogramcan also show hematomas. In infants, diagnosis and treatment involvethe removal of fluid through a needle inserted in the brain.

    Prevention & Expectations

    What can be done to prevent the condition?

    Prevention of chronic subdural hematoma requiresprotecting the head from injury. One way to do this is to useseat belts when in a car. Some head injuries can be avoidedby following sports safety guidelines for children,adolescents,and adults.Effective management of chronic conditions, such as diabetesand epilepsy,will further reduce the risk of head injury.

    What are the long-term effects of the condition?

    Chronic subdural hematoma can cause severe physical,emotional, and cognitive impairments.Relationships with family and friends can become disrupted. Theinjured person may no longer be able to function well at work.

    What are the risks to others?

    A chronic subdural hematoma poses no risk to others.

    Treatment & Monitoring

    What are the treatments for the condition?

    Once the chronic subdural hematoma is located, the doctorremoves it through surgery. If there is impairment from thiscondition, the person may need long-term treatment. Long-termtreatment involves joining a brain injury program and working witha team of specialists such as:

  • occupational therapists
  • physical therapists
  • physician
  • neuropsychologist
  • These specialists can help the person to learnnew coping strategies. Long-term treatment can continue for severalyears depending on the severity of symptoms.

    What are the side effects of the treatments?

    After surgery to remove the hematoma, some people maysuffer from nerve damage. This nerve damage may affect motorskills and the ability to carry out normal, daily activities.Seizures can also develop.

    What happens after treatment for the condition?

    If seizures develop, medicine will be needed tocontrol them. In infants, the doctor may also check for possiblechild abuse.

    How is the condition monitored?

    The doctor may recommend periodic visitsto watch for any return of symptoms. Any new or worseningsymptoms should be reported to the provider.

    Article type: xmedgeneral