Learn About Chronic Subdural Hematoma

What is the definition of Chronic Subdural Hematoma?

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.

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What are the alternative names for Chronic Subdural Hematoma?

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

What are the causes of Chronic Subdural Hematoma?

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 use of aspirin, anti-inflammatory drugs such as ibuprofen, or blood thinning (anticoagulant) medicine such as warfarin
  • Diseases that lead to reduced blood clotting
  • Head injury
  • Old age
What are the symptoms of Chronic Subdural Hematoma?

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:

  • Confusion or coma
  • Decreased memory
  • Problem speaking or swallowing
  • Trouble walking
  • Drowsiness
  • Headache
  • Seizures
  • Weakness or numbness of arms, legs, face
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What are the current treatments for Chronic Subdural Hematoma?

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).

Hematomas 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.

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What is the outlook (prognosis) for Chronic Subdural Hematoma?

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.

What are the possible complications of Chronic Subdural Hematoma?

Complications may include:

  • Permanent brain damage
  • Persistent symptoms, such as anxiety, confusion, difficulty paying attention, dizziness, headache, and memory loss
  • Seizures
When should I contact a medical professional for Chronic Subdural Hematoma?

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 convulsions (seizures)
  • Is not alert (loses consciousness)
How do I prevent Chronic Subdural Hematoma?

Avoid head injuries by using seat belts, bicycle and motorcycle helmets, and hard hats when appropriate.

What are the latest Chronic Subdural Hematoma Clinical Trials?
A Randomized Controlled Trial of Exhaustive Drainage Versus Fixed-time Drainage for Chronic Subdural Hematoma After One-burr Hole Craniostomy

Summary: A prospective, multicenter, randomized controlled trial is designed to compare the recurrence rates and clinical outcomes in patients with chronic subdural hematoma using exhaustive drainage or fixed-time drainage after one-burr hole craniostomy.

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Tranexamic Acid in Chronic Subdural Hematomas

Summary: BACKGROUND Chronic subdural hematoma (CSDH) is one of the most frequent reasons for cranial neurosurgical consult. There is no widely accepted medical treatment for CSDH. This trial will investigate whether Tranexamic Acid (TXA) can increase the rate of CSDH resolution following conservative management, lower the number of required surgical procedures and decrease the rate of CSDH recurrence follo...

What are the Latest Advances for Chronic Subdural Hematoma?
Burr hole craniostomy vs. minicraniotomy of chronic subdural hematoma: a systematic review and meta-analysis.
The Effect of Statins on the Recurrence of Chronic Subdural Hematomas: A Systematic Review and Meta-Analysis.
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Burr hole and craniotomy in the treatment of subdural hematoma: A comparative study.
Who are the sources who wrote this article ?

Published Date: May 02, 2022
Published By: Amit M. Shelat, DO, FACP, FAAN, Attending Neurologist and Assistant Professor of Clinical Neurology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY. 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.

What are the references for this article ?

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.

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.