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Chronic Subdural Hematoma: Overview

A chronic subdural hematoma is a slow buildup of blood between the brain and the membrane that covers it, known as the dura. This most commonly occurs as a result of a mild head injury that occurred at some time in the past; in fact, often the individual does not remember a specific episode of trauma.

Causes   

Tiny veins called bridging veins run between the dura and the surface of the brain. A subdural hematoma develops when these veins tear and leak blood, usually as the result of a head injury. A collection of blood then forms over the surface of the brain. In a chronic subdural collection, the problem is not discovered immediately and blood leaks from the veins slowly over time.

A subdural hematoma is more common in the elderly because normal brain shrinkage occurs with aging that stretches and weakens the bridging veins. Thus, these veins are more likely to break in the elderly, even after a minor head injury. Rarely, a subdural hematoma can occur spontaneously (i.e., not from an accident or injury).

Risks include head injury, old age, chronic use of aspirin, anti-inflammatory drugs such as Ibuprofen or blood thinning (anti-coagulant) medication, chronic heavy alcohol use, or many diseases associated with blood clotting problems.

Signs and symptoms

Symptoms of a chronic subdural hematoma can be subtle and may not be recognized for weeks to months after the injury. The most common symptoms include:

• Drowsiness
• Cognitive dysfunction
• Poor attention span

Other symptoms include:

• Headaches that get worse over time
• Nausea and vomiting
• Seizures
• Unequal size of the pupils of the eyes
• Vision changes such as blurred vision
• Weakness on one side of the body, known as hemiparesis

Treatment   

The goal is to control symptoms and minimize or prevent permanent damage to the brain. Corticosteroid medications may be used to reduce any swelling of the brain. Anticonvulsant medications, such as phenytoinHealth Fitness Articles, may be used to control or prevent seizures.

Surgery is often required. This may include drilling small holes in the skull to relieve pressure and allow blood to be drained. Large hematomas or solid blood clots may need to be removed through a larger opening in the skull


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