Chronic subdural hematoma

Chronic Subdural Hematoma (CSDH) is a type of hematoma that occurs beneath the dura mater, the outermost, toughest layer covering the brain. It typically develops over weeks to months following a minor head injury, often so minor that it may have been forgotten or overlooked. This condition is more common in the elderly due to brain atrophy, which makes the brain more susceptible to injury from even minor trauma. Chronic subdural hematomas are significant because they can lead to an increase in intracranial pressure, causing a range of neurological symptoms and potentially leading to life-threatening complications without timely intervention.

Causes and Risk Factors

The primary cause of a chronic subdural hematoma is head trauma. However, it is often associated with minor injuries that may not initially present with symptoms. Risk factors include advanced age, alcohol abuse, anticoagulant therapy, and conditions that predispose individuals to falls or minor head injuries. Chronic subdural hematomas are also more common in individuals with coagulopathies (disorders affecting blood clotting) or those on dialysis.

Symptoms

Symptoms of a chronic subdural hematoma can vary widely but typically develop gradually over weeks to months. They may include headache, confusion, memory disturbances, drowsiness, lethargy, weakness on one side of the body (hemiparesis), speech difficulties, and in severe cases, loss of consciousness. The slow development of symptoms is due to the gradual accumulation of blood in the subdural space, allowing the brain to compensate over time.

Diagnosis

Diagnosis of a chronic subdural hematoma is primarily based on medical history and imaging studies. Computed Tomography (CT) scans and Magnetic Resonance Imaging (MRI) are the main diagnostic tools, with CT scans being particularly useful for identifying the presence of blood accumulation beneath the dura mater.

Treatment

Treatment options for chronic subdural hematoma include conservative management for small, asymptomatic hematomas and surgical intervention for symptomatic cases. Surgical procedures may involve a burr hole drainage, where one or more holes are drilled into the skull to allow the blood to drain, or a craniotomy, where a section of the skull is temporarily removed to access and remove the hematoma. Post-surgical management may include observation, repeat imaging, and management of underlying risk factors to prevent recurrence.

Prognosis

The prognosis for individuals with a chronic subdural hematoma varies depending on the size and location of the hematoma, the patient's age, and overall health status. Early detection and treatment generally lead to a good prognosis, but complications such as recurrence, brain damage, and increased intracranial pressure can occur, potentially resulting in long-term neurological deficits or death.

Prevention

Prevention of chronic subdural hematoma involves minimizing risk factors for head injury, particularly in the elderly and those with conditions that predispose them to falls or bleeding. This may include managing anticoagulation therapy carefully, treating coagulopathies, and implementing measures to prevent falls.