DEAR DOCTOR K:
My mother is in her 70s. She fell a few weeks ago but seemed fine. Then she started to have double vision and some trouble with balance. A CT scan revealed a subdural hematoma. Her doctor advised only bed rest and medication. Does this seem reasonable to you?
A subdural hematoma (or hemorrhage) occurs when blood vessels near the surface of the brain burst. Blood collects beneath the dura mater. That’s the outermost layer of the brain’s protective covering. Here is an illustration of a subdural hematoma:
Most subdural hemorrhages result from trauma to the head. In some cases, blood accumulates rapidly after injury, putting pressure on the brain and causing symptoms within just a few days. This is an “acute” subdural hemorrhage. It can cause loss of consciousness, paralysis or even death. It usually requires emergency surgery to drain the hematoma and control bleeding.
Other times, as in your mother’s case, bleeding may develop over weeks or even months. If symptoms begin more than two weeks after the head trauma, it’s called a “chronic” subdural hematoma. The symptoms your mother experienced — double vision and trouble with balance — are typical. Other symptoms can include headache, nausea and vomiting, memory loss, and weakness, numbness or tingling in the arms and legs.
Although subdural hematomas can occur at any age, they are most likely to occur in people your mother’s age. That may be because blood vessels are more fragile as people reach their 70s.
Sometimes, chronic subdural hematomas develop without any head trauma at all — or at least without any head trauma a person remembers. I once had a patient with a subdural hematoma who had no memory of any head trauma. Later, his wife remembered that he had banged his head walking into the edge of a partially opened door at night.
Some conditions can cause subdural hematomas that occur without any head trauma. Weakness in artery walls can cause them to start leaking blood. Certain types of cancer that spread to the brain’s protective covering also can cause bleeding.
Treatment is based on symptoms and the size of the hematoma. A doctor can determine the amount of bleeding from a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan. If your mother’s hematoma is small and has caused only minimal symptoms, then it’s reasonable for the doctor to recommend bed rest and medications. The medications should help control swelling and prevent seizures. Symptoms should improve as her body gradually reabsorbs the blood. The doctor should carefully monitor your mother during treatment.
If your mother’s hemorrhage was larger or was causing more severe symptoms, a doctor would likely recommend surgery.
Most people who have a chronic subdural hemorrhage eventually get back to normal. With any brain injury, however, symptoms can be slow to go away after treatment. And some symptoms may be permanent.
Hopefully, your mother will recover on her own, as her doctor thinks she will. If so, she will most likely not experience permanent symptoms.