A chronic subdural hematoma (SDH) is a collection of blood on the
brain’s surface, under the outer covering of the brain (dura).
It usually begins forming several days or weeks after bleeding
initially starts. Bleeding is usually due to a head injury.
A chronic SDH doesn’t always produce symptoms. When it does, it
generally requires surgical treatment.
and Risk Factors
Major or minor trauma to the brain from a head injury is the most
common cause of a chronic SDH. In rare cases, one may form due to unknown
reasons, unrelated to injury.
The bleeding that leads to a chronic SDH occurs in the small
veins located between the brain’s surface and dura. When they break, blood
leaks over a long period of time and forms a clot. The clot puts increasing
pressure on your brain.
If you’re 60 or older, you have a higher risk for this type of
hematoma. Brain tissue shrinks as part of the normal aging process. Shrinking
weakens veins, so even a minor head injury may cause a chronic SDH.
Heavy drinking for several years is another factor that increases
your risk for chronic SDH. Other factors include using blood-thinning
medications, aspirin, and anti-inflammatory medications for a long period of
of Chronic Subdural Hematoma
Symptoms of this condition include:
- trouble walking
- impaired memory
- problems with vision
- trouble with speech
- trouble swallowing
- numb or weak face, arms, or legs
The exact symptoms that appear depend on the location and size of
your hematoma. Some symptoms occur more often than others. Up to 80
percent of people with this type of hematoma have headaches.
If your clot is large, loss of the ability to move (paralysis) can
occur. You might also become unconscious and slip into a coma. A chronic SDH
that puts severe pressure on the brain can cause permanent brain damage and
If you or someone you know exhibits symptoms of this condition,
it’s important to seek prompt medical help. People who have seizures or lose
consciousness need emergency care.
Chronic Subdural Hematoma
Your doctor will conduct a physical exam to look for signs of
damage to your nervous system, including:
- poor coordination
- problems walking
- mental impairment
- difficulty balancing
If your doctor suspects you have a chronic SDH, you’ll need to
undergo further testing. Symptoms of this condition are similar to symptoms of several
other disorders and illnesses that affect the brain, such as:
Tests like magnetic resonance imaging (MRI) and computed tomography
(CT) can lead to a more accurate diagnosis.
An MRI uses radio waves and a magnetic field to produce images of
your organs. A CT scan uses several X-rays to make cross-sectional pictures of
bones and soft structures in your body.
Options for Chronic Subdural Hematoma
Your doctor will focus on protecting your brain from permanent
damage and making symptoms easier to manage. Anticonvulsant drugs can help
reduce the severity of seizures or stop them from occurring. Drugs known as
corticosteroids relieve inflammation and are sometimes used to ease swelling in
Chronic SDH can be treated surgically. The procedure involves
making tiny holes in the skull so blood can flow out. This gets rid of pressure
on the brain.
If you have a large or thick clot, your doctor can temporarily
remove a small piece of skull and take out the clot. This procedure is called a
Outlook for Chronic Subdural Hematoma
If you have symptoms associated with a chronic SDH, you’ll likely
need surgery. The outcome of a surgical removal is successful for 80
to 90 percent of people. In some cases, the hematoma will return after
surgery and must be removed again.
to Prevent Chronic Subdural Hematoma
You can protect your head and reduce your risk of chronic SDH in
Wear a helmet when riding a bicycle or motorcycle. Always fasten
your seat belt in the car to decrease your risk of a head injury during an
If you work in a hazardous occupation such as construction, wear
a hard hat and use safety equipment.
If you’re over age 60, use extra caution in your daily activities
to prevent falls.