Chronic SDH
Introduction
A chronic subdural hematoma (Chronic SDH) is a collection of blood that slowly accumulates between the dura mater (the outermost brain covering) and the arachnoid layer of the meninges. It develops over weeks to months, typically following minor head trauma or in the absence of a clear injury. Chronic SDH is more common in older adults and individuals on anticoagulant therapy. While the condition can be asymptomatic initially, it can progress to cause significant neurological symptoms due to pressure on the brain.
Causes and Risk Factors
- Trauma: Even mild head trauma, especially in older adults, can tear bridging veins and lead to slow bleeding.
- Age-Related Changes: Brain atrophy in elderly individuals stretches veins, making them more susceptible to rupture.
- Anticoagulation and Antiplatelet Therapy: Medications like warfarin, aspirin, and direct oral anticoagulants increase the risk of bleeding.
- Alcohol Abuse: Chronic alcohol use weakens blood vessels and contributes to brain atrophy.
- Coagulopathies: Conditions that impair blood clotting, such as hemophilia or thrombocytopenia, increase susceptibility.
- Other Factors: Seizures, shunting for hydrocephalus, or vascular anomalies can contribute to chronic SDH
Symptoms of Chronic SDH
- Headache: Persistent, often mild but worsening over time.
- Cognitive Decline: Confusion, memory impairment, or personality changes
- Motor Deficits: Weakness, often on one side of the body (hemiparesis).
- Gait Disturbances: Difficulty walking or unsteadiness.
- Seizures: New-onset seizures can occur.
- Drowsiness or Coma: In severe cases, as the pressure on the brain increases.
Recovery and Rehabilitation
- Neurological Rehabilitation: Patients may require physical therapy, occupational therapy, or speech therapy based on deficits.
- Medications: Anticonvulsants may be prescribed to prevent seizures.
- Lifestyle Modifications: Avoid activities that increase the risk of head injury.
- Follow-Up Care: Regular imaging and neurological assessments to monitor recovery and detect recurrences.
Conclusion
Chronic subdural hematoma is a manageable condition with timely intervention. Advances in imaging, surgical techniques, and postoperative care have improved outcomes significantly. Awareness of risk factors, early recognition of symptoms, and appropriate medical care are key to preventing complications and achieving optimal recovery.