Beware! The fatal risk behind those minor bumps: chronic subdural hematoma

Author: Zhang Tong, Chief Physician, China Rehabilitation Research Center (Beijing Boai Hospital)

Reviewer: Xu Jun, Chief Physician, Beijing Tiantan Hospital, Capital Medical University

In our daily lives, we may have accidentally bumped our heads or fallen down. These seemingly insignificant accidents may sometimes hide huge health risks. Today, we are going to discuss an "invisible killer" hidden in the brain - chronic subdural hematoma. It is known for its hidden course and unclear symptoms in the early stage. It is more common in the elderly and infants, and often causes serious damage to the brain inadvertently.

Chronic subdural hematoma refers to the slow accumulation of blood in the subdural space, forming a blood clot that compresses the brain tissue. This process usually begins to show symptoms about three weeks after the injury.

Figure 1 Original copyright image, no permission to reprint

There are two main reasons why it is called the "invisible killer". First, the disease progresses slowly and the symptoms are not obvious in the early stage. Patients may only show mild headaches, dizziness or cognitive decline. These symptoms are particularly common in the elderly population and are easily confused with existing diseases such as Alzheimer's disease, leading to misdiagnosis or missed diagnosis. Secondly, the elderly and infants have limited ability to express themselves, and even if they feel uncomfortable, it is difficult to accurately describe it, which further increases the difficulty of diagnosis. By the time symptoms of increased intracranial pressure such as severe headaches and vomiting are obvious, the best time for treatment has often been missed, and the hematoma has caused irreversible damage to the brain tissue.

Infants and young children are another susceptible group. Their ability to express themselves is even more limited, and they can only express discomfort by crying. If parents fail to detect and seek medical treatment in time, the hematoma may rapidly increase, causing serious complications such as brain herniation, and even leading to sudden death. Therefore, chronic subdural hematoma is undoubtedly a potential fatal threat to the elderly and infants.

The cause of chronic subdural hematoma is still under study in the medical community. However, it is generally believed that this disease is closely related to minor head trauma. Due to memory loss and dull sensation, the elderly often find it difficult to recall whether they have had recent collisions or falls, which makes it particularly difficult to determine the history of trauma. However, even seemingly insignificant minor accidents, such as a light hit on the head by a hard object, may develop into a chronic subdural hematoma after weeks or even months. In addition, newborns may also suffer from this disease due to birth injuries during delivery, especially when the delivery process is not smooth or the midwifery instruments are used improperly.

The symptoms of chronic subdural hematoma vary, but they can be mainly summarized as follows: mental abnormalities, nervous system dysfunction, increased intracranial pressure, and cognitive decline. Patients may experience personality changes, mood swings, aphasia, hemiplegia and other symptoms, which seriously affect their daily lives. As the disease worsens, patients may also experience severe headaches, projectile vomiting and other manifestations of increased intracranial pressure. In addition, papilledema is also an important sign of chronic subdural hematoma, which requires a professional neurological examination to confirm the diagnosis.

In terms of diagnosis, doctors usually make a comprehensive judgment based on the patient's clinical manifestations, medical history, physical examination, and auxiliary examination results. Among them, CT scan is the key means of diagnosing chronic subdural hematoma. Through CT scan, doctors can clearly see the crescent-shaped hematoma in the subdural area and its characteristic imaging manifestations, thereby making a clear diagnosis. At the same time, doctors also need to make a differential diagnosis with other diseases that cause increased intracranial pressure to ensure the accuracy of the diagnosis.

Figure 2 Original copyright image, no permission to reprint

The treatment plan depends on the condition. In most cases, once symptoms appear, it means that surgical intervention is needed to remove the hematoma and relieve pressure on brain tissue. However, for asymptomatic chronic subdural hematomas, especially those discovered accidentally on CT scans, a conservative observation strategy can be adopted. This includes closely monitoring the patient's symptom changes, regularly checking the size of the hematoma, and immediately switching to surgical treatment once the hematoma increases or symptoms appear.