Chronic Subdural Hematoma

A chronic subdural hematoma is a buildup of blood between the brain and the membrane that covers it, known as the dura. This condition occurs as a result of a head injury and develops slowly over time. The trauma does not have to be serious to produce this condition.

What is going on in the body?

A chronic subdural hematoma begins when a vein ruptures. This causes slow bleeding into the space between the dura and the brain. Over time, the hematoma can enlarge. This puts pressure on the brain and produces mild to severe symptoms.

What are the causes and risks of the condition?

A chronic subdural hematoma 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. This causes shaken baby syndrome. During an indirect blow, the brain moves forcefully back and forth, hitting the inside of the skull.

Risk factors for chronic subdural hematoma include:

What are the signs and symptoms of the condition?

Symptoms of a chronic subdural hematoma can be hard to notice. They may not develop for weeks to months after the first injury. The most common symptoms include:

Other symptoms include:

How is the condition diagnosed?

Diagnosis of a chronic subdural hematoma begins with a complete medical history and physical exam. The doctor may order tests, such as a cranial CT scan. A cranial MRI or cerebral angiogram can also show hematomas. In infants, diagnosis and treatment involve the removal of fluid through a needle inserted in the brain.

What can be done to prevent the condition?

Prevention of chronic subdural hematoma requires protecting the head from injury. One way to do this is to use seat belts when in a car. 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.

What are the long-term effects of the condition?

Chronic subdural hematoma can cause severe physical, emotional, and cognitive impairments. Relationships with family and friends can become disrupted. The injured person may no longer be able to function well at work.

What are the risks to others?

A chronic subdural hematoma poses no risk to others.

What are the treatments for the condition?

Once the chronic subdural hematoma is located, the doctor removes it through surgery. If there is impairment from this condition, the person may need long-term treatment. Long-term treatment involves joining a brain injury program and working with a team of specialists such as:

These specialists can help the person to learn 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 hematoma, some people may suffer from nerve damage. This nerve damage may affect motor skills and the ability to carry out normal, daily activities. Seizures can also develop.

What happens after treatment for the condition?

If seizures develop, medicine will be needed to control them. In infants, the doctor may also check for possible child abuse.

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 provider.

Author:James Warson, MD
Date Written:
Editor:Crist, Gayle P., MS, BA
Edit Date:02/05/02
Reviewer:Pam Rosenthal, RN, BSN, CCM
Date Reviewed:02/10/02