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Home :: Neurology Disorders

Chronic Subdural Hematoma

 

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In such a case, a preceding injury to the skull would have taken place but is forgotten. Nearly 25% of patients fail to give any history of head injury. Subdural hemorrhages may cause an increase in intracranial pressure (ICP), which can cause compression of and damage to delicate brain tissue. Acute subdural hematoma (ASDH) has a high mortality rate and is a severe medical emergency . This chronic form is less risky, as pressure of the veins against the skull lessens the bleeding. Prompt medical care can reduce the probability of permanent brain damage.

The causative injury may be trivial e.g. striking the head against the branch of a tree, a sudden stop in a car with lurching forward, striking the head during a fall or againsta doorway. Symptoms appearing in less than 48 hours are due to an acute subdural hematoma. The causative injury may be trivial e.g. striking the head against the branch of a tree, a sudden stop in a car with lurching forward, striking the head during a fall or againsta doorway.

This is followed by a period of weeks or even months without any complaint till such time headaches appear, thinking becomes slow, confusion begins, changes in personality, seizures or a mild half body paresis. Memory begins to fail. Management is surgical.

Subdural hematomas most often affect people who are prone to falling. The trauma does not have to be serious to produce this condition. A chronic subdural hematoma is an "old" collection (several weeks after initial injury) of blood and blood breakdown products between the surface of the brain and its outermost covering (the dura). Unlike in epidural hematomas, which are usually caused by tears in arteries , subdural bleeding usually results from tears in veins that cross the subdural space . This is followed by a period of weeks or even months without any complaint till such time headaches appear, thinking becomes slow, confusion begins, changes in personality, seizures or a mild half body paresis. This enlargement can compress the brain itself, possibly leading to death if the lbood is not drained. Memory begins to fail. Typically, low-pressure venous bleeding of bridging veins (between the cortex and venous sinuses) dissects the arachnoid away from the dura and layers out along the cerebral convexity .

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). When the inciting event is unknown, the appearance of the hematoma on CT scan or MRI can help date the hematoma. Cerebral injury results from direct pressure, increased intracranial pressure (ICP), or associated intraparenchymal insults. A subdural hematoma (SDH) is a form of traumatic brain injury in which blood collects between the dura (the outer protective covering of the brain ) and the arachnoid (the middle layer of the meninges ). The time between the injury and the appearance of symptoms can vary from less than 48 hours to several weeks, or more.

Causes of Chronic Subdural Hematoma

The common Causes of Chronic Subdural Hematoma :

  • A subdural hematoma develops when tiny veins that run between the dura and the surface of the brain tear and leak blood.
  • Subdural hematomas are most often caused by head injury , when rapidly changing velocities within the skull may stretch and tear small bridging veins .
  • Chronic conditions such as diabetes , epilepsy , or alcoholism.
  • Risks include head injury, old age, chronic use of aspirin or blood thinning (anti-coagulant) medication, and chronic heavy alcohol use.
  • Chronic subdural hematoma is an important reversible cause of dementia and disability in the elderly.
  • A subdural hematoma is more common in the elderly because normal brain shrinkage occurs with aging that stretches and weakens the bridging veins.

Symptoms of Chronic Subdural Hematoma

Some common Symptoms of Chronic Subdural Hematoma :

  • Recent head injury.
  • Difficulty walking .
  • Disorientation.
  • Loss of consciousness after head injury.
  • Headache.
  • Difficulty speaking or swallowing .
  • Dizziness.
  • Numbness.
  • Seizures.
  • Weakness or numbness of arms, legs, face.
  • Nausea or vomiting.

Treatment of Chronic Subdural Hematoma

Here is the list of the methods for treating Chronic Subdural Hematoma :

  • Corticosteroid medications may be used to reduce any swelling of the brain.
  • Obtain an immediate head CT scan in patients with head trauma who experienced clear loss of consciousness, are symptomatic, are disoriented/amnestic, or have any focal neurologic signs.
  • Anticonvulsant medications, such as phenytoin, may be used to control or prevent seizures .
  • Burr holes are a temporizing option when rapid demise is associated with severe head trauma, especially if a herniation syndrome is clinically evident.
  • In infants, diagnosis and treatment involve the removal of fluid through a needle inserted in the brain.
  • After making a large cranial flap, open the dura.
  • Remove the clot with suction, cup forceps, and/or irrigation. Identify and control bleeding sites.
  • After surgery, anticonvulsant drugs (such as phenytoin) may help control or prevent seizures, which can begin as late as two years after the head injury.