Chronic Sub-dual Hematoma

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Overview

Haematoma is generally referred as a blood clot. It can appear as a bruise under the skin, which is called as skin hematoma. Skin haematomas are considered safe, but others forms of hematoma such as epidural, subdural and subchorionic haematoma are potentially dangerous.

Chronic Subdural Hematomas

Chronic subdural haematomas are also known as subdural haemorrhage (SDH). Chronic subdural hematomas are an old collection of blood on the surface of the brain beneath the outer covering (dura). For the same reason, the injury is also known as cerebral hematoma.

It often occurs after minor head trauma or less severe head injuries. Chronic subdural haematoma usually begins forming several days or weeks after bleeding originally starts. This is the reason why the cause of bleeding is not identified in 50 percent of cases, particularly in the elderly.

Classification of Subdural Hematomas

Subdural hemaetoma are usually life-threatening when acute, but chronic subdural haematomas have more chance of being cured if properly managed. Subdural haematomas can be classified into the following three types:

  • Acute Subdural Hematomas
  • Subacute Subdural Hematomas
  • Chronic Subdural Hematomas

This classification depends on the speed of their onset. Acute subdural hematomas are the most lethal and have a high mortality rate, if they are not treated immediately with surgical decompression.  

Chronic Subdural Hematomas: Causes

Chronic subdural haematomas usually occur because of bleeding due to head injury. In rare cases, it may form due to unknown reason and without any trauma.  

Some of the other risk factors for chronic cerebral haematomas include:

  • Heavy alcohol consumption over long period
  • Long period use of anti-inflammatory drugs such as ibuprofen, or blood thinning medicines such as aspirin, coumadin, warfarin and others
  • Diseases that lead to reduced blood clotting
  • Elderly age

Causes of Chronic Subdural Haematomas in Elderly Age

Chronic subdural hematomas often occur in elderly patients, mostly 60 and older who have brain atrophy. The main reason behind it is a brain tissue getting wasted or shrink due to age factor. When the brain shrinks inside the skull in elderly age, minor head injury can easily cause tearing of blood vessels over the brain surface (dura), resulting in a slow accumulation of blood.

Therefore, the risk of chronic subdural hematoma is higher in elderly people and it is increased even further if they receive anticoagulants.

Symptoms of Chronic Subdural Haematomas

There may not be any chronic subdural haematoma symptoms unless it grows larger and puts severe pressure on the brain. In an advance stage, it can cause permanent brain damage. The exact chronic subdural haematoma symptoms depend on the size and location of the hematoma.

The patients may experience the following symptoms:

  • Headache (most common)
  • Confusion
  • Impaired memory
  • Speech problems
  • Trouble in swallowing
  • Trouble in walking and balancing
  • Drowsiness
  • Headache
  • Vomiting
  • Seizures
  • Numbness or weakness of arms, legs, face

If the clot is large, paralysis and condition of coma can occur. It is important to seek emergency medical help in this condition and this is the reason why it is important to diagnose chronic subdural haematoma on time and treat it immediately.

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Before the Treatment

Chronic Subdural Haematoma Diagnosis

If your doctor thinks that you have a chronic subdural hematoma, you will be advised to undergo further testing. Typically it needs a test like magnetic resonance imaging (MRI) and computed tomography (CT) for accurate diagnosis.

How it is Performed

  • The primary goal of your doctor is to protect your brain from permanent damage and making symptoms easier to manage. A surgery is needed to treat chronic subdural haematomas permanently.
  • Usually, the procedure involves making small holes in the skull so blood can flow out; this procedure is called Burr-holes aspiration. This relieves the pressure from the brain.
  • However, if you have a larger blood clot, then another procedure called craniotomy is needed. In this procedure, the neurosurgeon will temporarily remove a small piece of skull to take out the clot.

Chronic Subdural Haematoma Treatment Without Surgery

  • Proper cure of chronic subdural haematoma requires surgical treatment. However, there are some temporizing medical maneuvers, which can be used to decrease intracranial pressure.
  • Some anticonvulsant drugs can help in cutting down the severity of seizures or stop them from occurring. Corticosteroids are used to help relieve inflammation and are sometimes used to ease swelling in the brain.

 

Recovery

Time After Surgery of Chronic Subdural Haematomas and Subdural Haemorrhage

Burr-hole surgery recovery time is less as compared to craniotomy. However, you need to stay in hospital for more than 3 to 5 weeks and need to rest at home for further 6 to 8 weeks. It is suggested to avoid any contact sport and activity which may have a risk of head injury for at least 12 weeks after the surgery.

Chronic Subdural Haematomas Complications

There are many complications associated with chronic subdural haematomas. However, these complications are rare and the doctors take all efforts to stop them from coming at the first place.

Some rare complications associated with chronic subdural haematomas may include:

  • Permanent brain damage
  • Seizures
  • Persistent symptoms, such as confusion, difficulty in paying attention, dizziness, anxiety, headache and memory loss

Chronic subdural haematoma may have some long-term side effects as well. These include emotional, physical and cognitive impairments.  However, if the chronic subdural haematomas is diagnosed and treated early, there are less chances of long term impairment.

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