Definition A chronic subdural haematoma is a buildup of blood between the membrane covering the brain, known as the dura, and the brain itself. This condition occurs as a result of a head injury and develops slowly over time. The trauma does not have to be significant to produce this condition.
What is going on in the body? A chronic subdural haematoma begins when a vein ruptures, causing slow bleeding into the space between the dura and the brain. Over time, the haematoma can enlarge, putting pressure on the brain and producing mild to severe symptoms.
What are the signs and symptoms of the condition? Symptoms of a chronic subdural haematoma can be very subtle and may not develop for weeks to months after the initial injury. The most common symptoms include:
a gradual change in alertness
poor attention span
decreased ability to use advanced cognitive skills, such as those used in processing new information, making decisions, and following complex instructions
What are the causes and risks of the condition? A chronic subdural haematoma is often caused by a direct blow to the head, such as hitting the head on a rock. It can also occur as a result of an indirect blow, such as when an infant is shaken violently, causing shaken baby syndrome. During an indirect blow, the head moves forcefully back and forth, hitting the inside of the skull.
Risk factors for chronic subdural haematoma include:
What can be done to prevent the condition? Prevention of chronic subdural haematoma involves protecting the head from injury, such as using seatbelts in motor vehicles. Some head injuries can be avoided by following sports safety guidelines for children, adolescents, and adults. Effective management of chronic conditions, such as diabetes and epilepsy, will further reduce the risk of head injury.
How is the condition diagnosed? Diagnosis of a chronic subdural haematoma begins with a complete medical history and physical examination. The doctor may order tests, such as a cranial CT scan. A cranial MRI and cerebral angiogram can also show haematomas. In infants, diagnosis and treatment involves the removal of fluid through a needle inserted in the brain.
What are the long-term effects of the condition? Chronic subdural haematoma can cause severe physical, emotional, and cognitive impairments. Relationships with family and friends can become disrupted and the injured person may no longer be able to function effectively at work.
What are the risks to others? A chronic subdural haematoma poses no risk to others.
What are the treatments for the condition? Once the chronic subdural haematoma is located, it is removed surgically. If a person develops any impairments from this condition, long-term treatment may be necessary. Long-term treatment involves participating in a brain injury program and working with a team of specialists comprised of occupational therapists, physiotherapists, a physician, and neuropsychologist to assist the person in learning new coping strategies. Long-term treatment can continue for several years depending on the severity of symptoms.
What are the side effects of the treatments? After surgery to remove the haematoma, some people may suffer from nerve damage. As a result, motor skills, and the ability to carry out normal, daily activities may be affected. Seizures can develop.
What happens after treatment for the condition? If seizures develop, medication will be necessary to control them. In infants, checking for possible child abuse may also be indicated.
How is the condition monitored? The doctor may recommend periodic visits to watch for any return of symptoms. Any new or worsening symptoms should be reported to the doctor.
Author: James Warson, MD Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 26/10/2004 Contributors Potential conflict of interest information for reviewers available on request
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