Understanding Chronic Subdural Hematoma: Causes, Symptoms, and Treatment

Dr. Suresh Kumar, Senior Consultant and HOD of Neurosurgery, SUT Hospital, Pattom

Chronic subdural hematoma (CSDH) is a serious condition that affects the brain, often leading to debilitating symptoms if left untreated. Despite its prevalence, many people are unfamiliar with this condition and its potential consequences.

What is Chronic Subdural Hematoma?

Chronic subdural hematoma refers to the accumulation of blood between the surface of the brain and its outermost covering, known as the dura mater. Unlike acute subdural hematomas, which develop rapidly following a traumatic head injury, chronic subdural hematomas tend to evolve slowly over weeks or months. They are more commonly seen in older adults, often occurring after minor head trauma or without any apparent cause.

Causes of Chronic Subdural Hematoma

• Head trauma- Minor injuries, such as a fall or bump to the head.
• Age- The risk of CSDH increases with age.
• Blood-thinning medications- Anticoagulant therapy increases the risk of bleeding within the brain.
• Alcoholism- Chronic alcohol abuse can weaken blood vessels and increase the likelihood of spontaneous bleeding.
• Underlying medical conditions- Certain medical conditions, such as epilepsy or coagulopathy.

Symptoms

The symptoms of chronic subdural hematoma can vary widely depending on the size and location of the hematoma.

• Headaches
• Confusion or altered mental status
• Weakness or numbness in the limbs
• Changes in behaviour or personality
• Difficulty speaking or understanding language
• Seizures

It is essential to recognize these symptoms and seek medical attention promptly, as untreated chronic subdural hematomas can lead to serious complications, including coma and death.

Diagnosis and Treatment

Diagnosis typically involves a thorough neurological examination and imaging studies, such as CT scans or MRI. Once diagnosed, treatment options may include:

• i. Observation

Small, asymptomatic hematomas may be monitored closely without intervention.

• ii. Medication

Steroids or diuretics may be prescribed to reduce swelling and alleviate symptoms.

• iii. Surgical drainage

For larger or symptomatic hematomas, surgical intervention may be necessary to remove the accumulated blood and relieve pressure on the brain.

The choice of treatment depends on various factors, including the patient’s overall health, the size and location of the hematoma, and the severity of symptoms.

By understanding the causes, symptoms, and treatment options for CSDH, individuals can take proactive steps to seek medical attention if needed. Early intervention can make a difference in the prognosis and quality of life for individuals affected by this condition.