Chronic Subdural Hematomas

A chronic subdural hematoma (cSDH) is a collection of blood between the brain’s surface and its outer covering (the dura) that develops slowly over days to weeks after a head injury. The bleeding comes from small veins that tear, often from a minor bump or fall. Over time, the blood can put pressure on the brain and cause symptoms.

cSDH most often affects older adults, especially those over age 60, because aging brains shrink slightly, stretching the veins and making them more prone to injury. It can also occur in people taking blood-thinning medication or those with certain medical conditions.

Causes and Risk Factors You Cannot Control

• Increasing age
• Male sex
• History of prior head injury
• Brain atrophy from age or medical conditions

Causes and Risk Factors You Can Control

• Use of blood-thinning medications without monitoring
• Heavy alcohol use
• Activities with a high risk of head injury without protective gear

Who Is Most at Risk?

• Adults over 60
• People who take anticoagulants or antiplatelet medicines
• Individuals with frequent falls or balance problems
• Those with a history of repeated head trauma

Steps to Reduce Your Risk

• Wear a helmet during activities like biking or contact sports
• Manage fall risks at home by removing tripping hazards and using assistive devices if needed
• Have your blood-thinning medications regularly monitored
• Limit alcohol consumption

Symptoms may appear gradually and can be subtle at first. Common signs include:

• Persistent headache
• Confusion or memory problems
• Weakness or numbness on one side of the body
• Trouble with speech or vision
• Difficulty with balance or walking
• Seizures

In older adults, symptoms may be mistaken for dementia or stroke, so timely evaluation is important.

How It Is Diagnosed

A healthcare provider will review your medical history, perform a neurological exam, and order imaging tests to confirm the diagnosis.

Tests Used

• CT scan: Quick imaging to detect bleeding and pressure on the brain
• MRI: Detailed images to assess size, location, and age of the hematoma
• Blood tests: To check for clotting problems or medication effects

Lifestyle

• Prevent further head injuries by using fall-prevention strategies and helmets where appropriate
• Manage medications that affect blood clotting under your doctor’s supervision

Medical

• Adjusting or stopping blood-thinning medications
• Treating underlying causes of bleeding
• Managing symptoms like headaches or seizures

Procedural and Surgical

• Neurovascular treatment: Minimally invasive catheter-based treatments, such as middle meningeal artery embolization, may be used to block blood supply to the hematoma’s membrane and reduce recurrence risk
• Burr hole drainage: Small openings in the skull allow blood to be removed
• Craniotomy: A larger opening is made for more complex or recurrent hematomas

Other

• Observation with regular imaging if the hematoma is small and symptoms are mild

When to See Your Doctor

• You have a new or worsening headache after even a minor head injury
• You notice changes in memory, mood, or movement
• You develop balance problems or speech difficulties

When to Seek Emergency Medical Care

• Sudden weakness or numbness
• Loss of consciousness
• Seizure
• Severe, sudden headache

If you or a loved one has symptoms of a chronic subdural hematoma, seek prompt medical attention. Early diagnosis and treatment can prevent serious complications and improve recovery.