Assessing Risk of Chronic Subdural Hematoma After Head Injury

Head trauma

Hello Doctor, my father is 52 years old and has a history of liver cirrhosis, currently undergoing medication treatment.
Last week, he accidentally hit his head hard when closing the car door.
The pain lasted for about two minutes, and there was no loss of consciousness or any other discomfort afterwards.
What is the likelihood of developing a chronic subdural hematoma? Should he see a neurologist for an examination or just observe for now? How many days should we monitor him? Thank you, Doctor.

Mr. Huang, 50~59 year old female. Ask Date: 2023/01/31

Dr. Jiang Junyi reply Neurology

Hello Mr.
Huang,
You mentioned that "the rear door accidentally hit my head after closing, it was quite forceful, and it hurt for about two minutes.
There was no loss of consciousness, and I did not experience any other discomfort." Generally speaking, if there is no loss of consciousness, no anticoagulant medication taken, or obvious local hematoma, head injuries are mostly minor.
Trauma to the head caused by sudden direct or indirect force can affect brain function.
The severity of a brain injury can range from minor injuries that heal on their own to severe damage to brain nerves and tissues, leading to secondary ischemic brain lesions.
Delayed intracranial hemorrhage typically occurs within 48 hours, with an incidence of about 5%.
However, if any of the following symptoms occur, you should consider the possibility of delayed bleeding and seek emergency care: (1) worsening vision, seeing double (diplopia), or unequal pupil size; (2) watery fluid or blood leaking from the ears or nose; (3) confusion or abnormal behavior; (4) numbness or inability to move limbs; (5) involuntary twitching or seizures.
If symptoms persist without improvement, I recommend consulting a neurosurgeon for evaluation and treatment.
If there is rapid progression, please go to the emergency room.
Thank you for your inquiry.
Feel free to discuss further.
Wishing you good health and peace.
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2023/01/31

More Info

When assessing the risk of chronic subdural hematoma (CSDH) after a head injury, several factors must be considered, especially in the context of your father's medical history and the nature of the injury he sustained.
Chronic subdural hematomas typically develop in individuals who have experienced a head trauma, particularly in older adults or those with certain risk factors such as anticoagulant therapy, alcohol abuse, or pre-existing conditions like liver disease, which can affect blood clotting. Your father's history of liver cirrhosis raises concerns, as this condition can lead to thrombocytopenia (low platelet count) and coagulopathy (impaired blood clotting), both of which increase the risk of bleeding complications.

In your father's case, the mechanism of injury—a door slamming against his head—could potentially cause a subdural hematoma, especially if there was significant force involved. The fact that he experienced pain for a couple of minutes but did not lose consciousness or exhibit other immediate symptoms is reassuring, but it does not completely rule out the possibility of a delayed hematoma formation.

CSDH can take days to weeks to manifest, and symptoms may include headaches, confusion, dizziness, or changes in behavior. Given your father's medical history and the nature of the injury, it is prudent to monitor him closely for any signs of neurological changes.
As for whether he should see a neurologist or undergo imaging studies, it is advisable to err on the side of caution. If he begins to experience any new symptoms such as persistent headaches, confusion, or changes in his level of consciousness, he should seek medical attention immediately. In the absence of symptoms, a follow-up with a neurologist may be warranted within a week or two to evaluate the need for imaging, such as a CT scan, to rule out any bleeding.

In summary, while the risk of developing a chronic subdural hematoma after a seemingly minor head injury is relatively low, especially in a younger individual, your father's underlying liver condition and the nature of the injury necessitate careful observation. If any concerning symptoms arise, prompt medical evaluation is essential. Regular follow-up with a healthcare provider can help ensure that any potential complications are identified and managed early.

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