Chronic Subdural Hematoma: Causes, Diagnosis and Treatments

Written by Medicover Team and Medically Reviewed by Dr Bhagwan Motiram Aage , Neurosurgeons

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

A chronic subdural hematoma is a collection of blood that accumulates slowly between the dura mater, the brain's tough outer membrane, and the arachnoid mater. Unlike an acute subdural hematoma, which develops rapidly after severe head trauma, a chronic subdural hematoma forms gradually over weeks or months, often following a minor head injury. It is more common in older adults and individuals taking blood-thinning medications.

What are the Symptoms of Chronic Subdural Hematoma?

The symptoms of a chronic subdural hematoma depend on its size, location, and the amount of pressure it places on the brain. Symptoms often develop gradually and may initially be mistaken for normal aging or other neurological conditions.

Persistent headaches.
Confusion or cognitive decline.
Weakness or numbness on one side of the body.
Difficulty walking or maintaining balance.
Memory problems.
Personality or behavioral changes.

Because these symptoms progress slowly, early medical evaluation is important to prevent serious complications.

What are the Causes of Chronic Subdural Hematoma?

Chronic subdural hematoma usually develops due to slow bleeding from small veins between the brain and the dura. Several factors increase the risk of this condition.

Minor Head Trauma

Minor head injuries are the most common cause, particularly in older adults. Brain shrinkage with aging stretches the bridging veins, making them more susceptible to tearing even after mild trauma.

Coagulopathy

Bleeding disorders and the use of anticoagulant or antiplatelet medications increase the likelihood of prolonged bleeding, contributing to hematoma formation.

Age-Related Changes

As the brain naturally shrinks with age, additional space develops between the brain and skull, allowing blood to accumulate gradually without immediate symptoms.

When to See a Doctor for Chronic Subdural Hematoma?

If you experience persistent headaches, confusion, memory problems, weakness, balance difficulties, or any neurological symptoms following a head injury, seek prompt medical attention. Consult a Neurosurgeon for a thorough evaluation. Early diagnosis and treatment can prevent serious complications, reduce pressure on the brain, and improve recovery outcomes.

If you have persistent or worsening headaches, especially after a recent or past head injury.
If you experience confusion, memory loss, drowsiness, or changes in behavior or personality.
If you develop weakness or numbness in the arms or legs.
If you have difficulty walking, poor balance, or coordination problems.
If you experience slurred speech, blurred vision, or difficulty understanding or communicating.
If you develop seizures or episodes of loss of consciousness.
If you are an older adult or take blood-thinning medications and notice new neurological symptoms after even a minor head injury.
If you develop severe headache, repeated vomiting, sudden weakness, loss of consciousness, or difficulty breathing, seek immediate emergency medical attention.
If your symptoms persist or worsen, consult a Neurosurgeon for a comprehensive evaluation, appropriate brain imaging, diagnosis, and a personalized treatment plan.

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How is Chronic Subdural Hematoma Diagnosed?

Diagnosing chronic subdural hematoma involves a clinical assessment and imaging studies to determine the presence, size, and severity of the bleeding.

Neurological Examination

A comprehensive neurological examination evaluates memory, speech, reflexes, muscle strength, coordination, sensation, and balance to identify neurological deficits.

Imaging Studies

Computed Tomography (CT) Scan: A CT scan is the primary imaging test used to detect chronic subdural hematoma and assess its size and location.
Magnetic Resonance Imaging (MRI): MRI provides more detailed images of the brain and may help distinguish chronic subdural hematoma from other neurological disorders.

How is Chronic Subdural Hematoma Treated?

Treatment depends on the size of the hematoma, symptom severity, and the patient's overall health.

Conservative Management

Small hematomas causing minimal or no symptoms may be managed with regular neurological assessments and follow-up CT or MRI scans to monitor for changes.

Surgical Intervention

Larger hematomas or those causing neurological symptoms usually require surgical treatment to relieve pressure on the brain.

Burr Hole Drainage: A minimally invasive procedure in which one or more small holes are drilled into the skull to drain the accumulated blood.
Craniotomy: A more extensive surgical procedure performed to remove large, organized, or recurrent hematomas by temporarily removing part of the skull.

Postoperative Care

Following surgery, patients require close monitoring for recurrence, infection, seizures, or neurological complications. Rehabilitation may be recommended to improve strength, balance, mobility, and cognitive function.

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What is the Difference Between Chronic Subdural Hematoma and Acute Subdural Hematoma?

Although both conditions involve bleeding between the brain and the dura mater, they differ in their onset, causes, and clinical presentation.

Chronic Subdural Hematoma: Develops gradually over weeks or months, usually after minor head trauma, with slowly progressing neurological symptoms.
Acute Subdural Hematoma: Occurs immediately after a severe head injury and often causes rapid neurological deterioration, severe headache, loss of consciousness, and requires emergency treatment.

Frequently Asked Questions

1. What are the symptoms of chronic subdural hematoma?

Symptoms may include headache, confusion, and neurological deficits, indicating a collection of blood on the brain's surface requiring immediate medical evaluation.