ONE-PAGE on chronic subdural haematoma (CSDH)
Subdural haematomas are commoner in the elderly and can occur acutely, presenting within hours of a head injury, or more slowly as the classical chronic subdural haematoma. In the latter the injury may have been trivial and forgotten. Only about half the patients will give a history of head injury.
CSDH may present with slowed thinking, incoherence of thought and inattentiveness. This is why it is considered a form a dementia.
Focal signs such as hemiparesis are uncommon in CSDH. Headache and drowsiness and falls may occur.
Bilateral CSDH may produce perplexing clinical syndromes mimicking stroke, brain tumour, drug intoxication, depression or dementia.
CT scan (without contrast) reveals crescent shaped haematoma compressing sulci. This mass of blood appears hyperdense (white) for first two weeks, becomes isodense (same colour as brain matter) between week 2 and week 6 and then becomes hypodense (black).
MRI is slightly superior to CT as it can detect haematomas which are isodense on CT and also very small haematomas.
About one third of patients with CSDH will end up having surgery. Burrhole surgery with evacuation of the haematoma is done under LA. Improvement is often dramatic though in some cases drowsiness or confusion persists for long periods.
Small minimally symptomatic CSDH are sometimes treated with steroids.
An important duty of a family physician on suspecting a possible subdural haematoma is to stop anti-platelet and anti-coagulant drugs.