Chronic Subdural Hematoma After Car Accidents: Care and Recovery

Traumatic brain hemorrhage from a car accident?

My grandfather was in a car accident in Pingtung on April 13 of this year.
At the time, he didn't seem to have any serious injuries, only some minor abrasions.
The local hospital in Pingtung only examined his external injuries and did not check for internal injuries.
However, on July 6, he began to exhibit signs of confusion, incoherent speech, an inability to walk or talk independently, and severe memory issues, forgetting what he had just done moments before.
He was then taken to a hospital in Hsinchu for further examination, where it was discovered that he had been accumulating blood for a long time, which had formed a clot and turned into black blood.
The diagnosis was "chronic subdural hematoma," and he underwent a drainage surgery.

One week post-surgery, he showed good recovery, able to converse and perform basic self-care, and the drainage tube was removed.
However, how long will it take for him to fully recover? What constitutes complete recovery? Should we consider letting him return to live in Pingtung (where medical facilities are more limited, but neighbors can provide better care)? In Hsinchu, there is no one to care for him from Monday to Friday, which makes the situation very difficult.
We are constantly weighing the considerations of caregiving and medical needs.
What should we pay attention to in his care? Thank you, doctor, for taking the time to read and respond.

Shao, 10~19 year old female. Ask Date: 2019/07/14

Dr. Zhang Junwei reply Neurosurgery

Theoretically, as long as the initial neurological impairment is not severe, almost complete recovery is possible.
Whether the patient can live independently or requires assistance from others needs to be assessed in detail; it is difficult to answer this question online.

Reply Date: 2019/07/14

More Info

Chronic subdural hematoma (CSDH) is a condition that can arise after head trauma, even if the initial injury seems minor. In your grandfather's case, it appears that he sustained a head injury during the car accident in April, which went unnoticed at the time. The symptoms he experienced in July, such as confusion, memory issues, and difficulty walking and speaking, are indicative of a CSDH, which can develop weeks or even months after the initial injury.
After the drainage surgery, it is encouraging to hear that your grandfather has shown signs of recovery, such as being able to talk and perform basic self-care tasks. However, the timeline for complete recovery can vary significantly from person to person. Factors influencing recovery include the patient's age, overall health, the extent of the hematoma, and the presence of any underlying conditions. Generally, it may take several weeks to months for a patient to regain full cognitive and physical function after a CSDH.
Complete recovery from a CSDH is often defined by the restoration of cognitive functions, the ability to perform daily activities independently, and the absence of symptoms such as confusion or memory loss. It is essential to have regular follow-ups with a neurologist or neurosurgeon to monitor your grandfather's progress and to assess any potential complications that may arise.

Regarding your question about relocating your grandfather back to Pingtung, this decision should consider both his medical needs and the availability of support. While Pingtung may have a more familiar environment and neighbors who can assist, the lack of adequate medical facilities could pose a risk if he requires ongoing medical attention or rehabilitation services. If he is discharged to a home environment where he will be alone during the weekdays, it may be beneficial to explore options for in-home care or community services that can provide assistance.

In terms of care, here are some recommendations to ensure your grandfather's well-being during his recovery:
1. Supervision and Assistance: Since he may still experience confusion or mobility issues, having someone available to assist him, especially during the initial recovery phase, is crucial. Consider arranging for a caregiver or family member to check in on him regularly.

2. Cognitive Rehabilitation: Engaging in cognitive exercises can help improve memory and cognitive function. Simple activities like puzzles, reading, or memory games can be beneficial.

3. Physical Therapy: If mobility is still an issue, physical therapy can help improve strength and coordination. A physical therapist can create a tailored exercise program to address his specific needs.

4. Medication Management: Ensure that he is taking any prescribed medications as directed and monitor for any side effects or changes in his condition.

5. Regular Follow-ups: Schedule regular appointments with his healthcare providers to monitor his recovery and make any necessary adjustments to his care plan.

6. Safety Modifications: Make necessary modifications in the home to prevent falls, such as removing tripping hazards, ensuring adequate lighting, and possibly installing grab bars in the bathroom.

7. Emotional Support: Recovery from a brain injury can be emotionally challenging. Providing emotional support and encouraging social interactions can help improve his overall well-being.

In conclusion, while your grandfather's initial recovery seems promising, ongoing care and monitoring will be essential in ensuring his complete recovery. Balancing his medical needs with the support available in his living environment will be key in making the best decision for his health and quality of life.

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