Chronic Subdural Hematoma: Symptoms and Timeline

Chronic subdural hematoma

Chronic subdural hematoma can occur weeks to months after an initial head injury, but it is possible for symptoms to develop even up to several years later, including 1 or 2 years after the injury.
It can lead to facial weakness and may also cause neck stiffness and swelling, depending on the extent of the condition and associated complications.

Vickey, 10~19 year old female. Ask Date: 2016/02/14

Dr. Jiang Junyi reply Neurology

According to your description, chronic subdural hematoma is commonly seen in the elderly, with an average onset age of 63 years.
Approximately 50% of patients can trace a history of head trauma occurring one to two months prior to the onset of symptoms.
Due to the diverse clinical manifestations, it is often misdiagnosed as a stroke and sent to the emergency department.
A computed tomography (CT) scan of the brain can serve as a diagnostic tool.
The mechanism of chronic subdural hematoma is completely different from that of acute subdural hematoma.
Generally, after head trauma, subdural bleeding may occur, damaging the arachnoid membrane and leading to the formation of subdural edema.
Subsequently, the edema undergoes an inflammatory response, forming a membrane and generating granulation tissue, which is rich in blood vessels and creates a pseudo-capsule.
The capillaries are numerous and fragile; when they rupture, blood and plasma leak out, forming a hematoma.
Based on the timing of bleeding after injury, it can be classified into three types: 1.
Acute, occurring within 72 hours; 2.
Subacute, occurring from three days to three weeks; 3.
Chronic subdural hematoma, occurring after three weeks.
Symptoms of chronic subdural hematoma are varied and can range from mild headache, altered consciousness, and speech difficulties to stroke-like symptoms, coma, limb weakness, or seizures.
In younger individuals, symptoms often present as increased intracranial pressure, such as headache, vomiting, papilledema, altered consciousness, hemiparesis, sensory deficits, or aphasia.
In the elderly, symptoms may manifest as psychological changes, fatigue, and memory decline, which can easily be overlooked.
It is recommended that you consult a neurosurgeon for discussion and treatment.
Wishing you good health, peace, and joy.

Reply Date: 2016/02/14

More Info

Chronic subdural hematoma (CSDH) is a condition that occurs when blood collects between the outer layer of the brain (the dura mater) and the inner layer (the arachnoid mater) over a prolonged period. This condition is often associated with head trauma, but it can also develop in individuals without a clear history of injury, particularly in older adults or those on anticoagulant therapy.

Timeline for Development
CSDH typically develops weeks to months after an initial head injury. While it is most commonly seen within the first few weeks to three months post-injury, it can indeed appear much later. There are documented cases where CSDH has developed one year or even two years after the initial trauma. This delayed presentation is particularly common in elderly patients, where the brain may atrophy, making the bridging veins more susceptible to tearing from minor trauma that might not have caused significant symptoms initially.

Symptoms
The symptoms of chronic subdural hematoma can be quite variable. Common symptoms include:
1. Headache: Often the most prominent symptom, which may be persistent or intermittent.

2. Cognitive Changes: Memory problems, confusion, or changes in personality can occur as the hematoma exerts pressure on the brain.

3. Neurological Deficits: Weakness or numbness in the limbs, difficulty with coordination, or changes in speech may be observed.

4. Seizures: Some patients may experience seizures as a result of the hematoma.

5. Gait Disturbances: Difficulty walking or balance issues can also be present.

Specific Concerns
Regarding your specific concerns about facial weakness and neck stiffness:
- Facial Weakness: This can occur if the hematoma is large enough to compress areas of the brain responsible for motor function. The facial nerve can be affected, leading to weakness on one side of the face.

- Neck Stiffness: While neck stiffness is not a classic symptom of CSDH, it may occur if there is associated irritation of the meninges (the protective layers surrounding the brain and spinal cord) or if there is increased intracranial pressure. However, neck stiffness is more commonly associated with conditions like meningitis.

Conclusion
If you or someone you know is experiencing symptoms such as facial weakness or neck stiffness, it is crucial to seek medical evaluation promptly. A healthcare provider may recommend imaging studies, such as a CT scan or MRI, to assess for the presence of a chronic subdural hematoma or other potential causes of these symptoms. Early diagnosis and management are essential to prevent further complications, including permanent neurological deficits.

In summary, chronic subdural hematoma can indeed develop long after an initial injury, and it can lead to a variety of neurological symptoms. If there are concerns about symptoms like facial weakness or neck stiffness, it is essential to consult a healthcare professional for a thorough evaluation and appropriate management.

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