What is chronic subdural haematoma (CSDH)?
Chronic subdural haematoma (CSDH) is a collection of liquefied blood and blood breakdown products between the surface of the brain and its outmost covering (the dura).
What are the symptoms?
What causes CSDH?
Small veins called “bridging veins” run between the dura and the surface of the brain. A subdural haematoma develops when these veins tear and leak blood, usually as the result of a head injury. A collection of blood forms over the surface of the brain. Membranes develop around the blood clot which slowly liquefies. Repeated small bleeds from the membranes cause it to grow in size after several weeks. As a result, the problem is usually not discovered immediately. Its presence becomes known only weeks after the initial injury. The chronic subdural haematoma can develop on one or both sides of the brain.
Who are at risk?
They are common in the elderly and chronic alcoholic because presence of brain shrinkage results in more brain movement when the head is accidentally hit even during a minor head injury. The bridging veins are stretched more and are more liable to be injured. Rarely, a subdural haematoma can occur spontaneously without there being an accident or injury.
People with chronic use of aspirin or anti-coagulant (blood thinning) medications, or diseases associated with blood clotting problems are at risk for developing CSDH.
How is it diagnosed?
Is surgery necessary?
Few chronic subdural haematomas heal themselves over time. They often require surgery, particularly in the case of significant brain compression, neurological problems, seizures or chronic headaches.
Since the blood is in a liquefied state, surgery is usually carried out by drilling two small holes (burr-hole) in the skull to allow blood to be drained away. Solid blood clots may need to be removed through a larger opening (craniotomy) in the skull. One or two drains are usually placed to drain blood and fluid from the operation site to prevent recollection.
Post surgery, the patient will be transferred back to the ward for monitoring and nursed flat in bed during the immediate post-operative period to allow the brain to re-expand.
On the second day after operation, the drain will be removed and patient will be able to sit up in bed or walk about as tolerated.
What is the long term outcome?
Some chronic subdural haematomas return after drainage, and repeat surgery may be necessary.
Most people can be discharged after 5-7 days post operatively. Eventually, the person is able to resume normal activities. Those with significant preoperative disability may need to undergo a period of rehabilitation.
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