Chronic subdural haematoma awareness

Overview

A chronic subdural haematoma (say: sub-DUR-al hee-mah-TOH-mah) is a slow buildup of blood between the brain and its tough outer covering (the dura). It usually happens over weeks after a minor head injury, especially in older adults or people taking blood-thinning medicines.

Chronic subdural haematoma is fairly common, especially in people over 60. It affects about 1 in 10,000 people each year, but the risk increases sharply with age.

It most often affects older adults, people who take blood thinners (like warfarin or aspirin), those who drink heavy amounts of alcohol, and people with epilepsy or balance problems that lead to falls. It can also occur in children but is much rarer.

Symptoms

Common symptoms

• Persistent headache that may come and go
• Confusion or trouble thinking clearly
• Slurred speech or difficulty finding words
• Weakness or numbness on one side of the body
• Problems with walking – shuffling, stumbling, or feeling unsteady
• Drowsiness or feeling unusually tired
• Changes in mood or personality, like irritability or depression

Symptoms in children

• Irritability or excessive crying
• Vomiting without a clear cause
• A bulging soft spot on the top of the head (fontanelle) in babies
• Poor feeding or drowsiness
• Seizures (fits)

Symptoms in older adults

• Slow, unsteady walking or frequent falls
• Memory loss that seems worse than usual
• Confusion that comes and goes
• Slowed thinking or trouble concentrating
• Changes in sleep patterns – sleeping more or less
• Depression or loss of interest in activities

Causes

Main causes

• A minor head injury – such as bumping your head on a cabinet or a fall from standing height – that causes a slow leak of blood
• Sometimes there is no known injury, especially in older adults whose brains have shrunk a bit, putting more stretch on the blood vessels

Risk factors

• Older age (over 60)
• Taking blood-thinning medicines (anticoagulants like warfarin, apixaban, or rivaroxaban) or antiplatelet drugs (like aspirin, clopidogrel)
• Heavy alcohol use, which can affect the liver and blood clotting
• Medical conditions that increase bleeding risk, such as haemophilia or low platelet count
• Epilepsy or balance disorders that cause falls
• Dementia, which increases fall risk
• Previous brain surgery

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency symptoms listed above, call your local emergency number immediately.
• If you have new confusion, weakness, or difficulty speaking, see a doctor the same day – go to an urgent care centre or emergency department.

Book a routine appointment if:

• If you have a persistent headache that does not improve with simple pain relief, or if you notice gradual changes in your thinking, walking, or strength, make an appointment with your GP or family doctor.
• If you have had a minor head injury and later develop any new symptoms, even weeks later, get checked.

Diagnosis

A doctor will ask about your symptoms, any recent head injuries or falls, and your medical history. They will do a neurological exam – checking your strength, reflexes, coordination, eye movements, and mental sharpness. If they suspect a chronic subdural haematoma, they will order a brain scan.

Tests that may be done

• CT scan (computed tomography) – the most common and quickest scan to show bleeding
• MRI scan (magnetic resonance imaging) – can give a more detailed picture if needed
• Blood tests – to check for bleeding disorders or how well your blood clots

What to expect at your appointment

You will lie still while the scanner takes pictures of your brain. The tests are painless and usually take about 15–30 minutes. The doctor will explain the results and what treatment, if any, is needed.

Treatment

Treatment depends on the size of the haematoma, your symptoms, and your overall health. Small bleeds with no symptoms may just be watched. Larger ones causing symptoms often need surgery to drain the blood. Medicines are used to manage symptoms and, if you are on blood thinners, to reverse their effects (under close medical supervision).

Self-care at home

• Follow your doctor’s advice about rest and activity – avoid heavy lifting, bending, or straining.
• Do not drive until a doctor says it is safe, especially if you have had drowsiness, weakness, or seizures.
• Avoid activities that could lead to another head injury, like contact sports or climbing ladders.
• Watch for any new or worsening symptoms and report them promptly.

Medical treatments

If you are on blood-thinning medicines, your doctor may adjust or temporarily stop them (always under medical guidance). Steroid medicines (such as dexamethasone) can sometimes help reduce swelling around the haematoma. Other medicines may be given to control headache, seizures, or pain – always as prescribed by a healthcare professional.

When is surgery considered?

Surgery is the most common treatment for chronic subdural haematoma that is causing symptoms. The usual operation is called a burr hole drainage, where a small hole is drilled in the skull to let the blood out. Sometimes a larger opening (craniotomy) is needed. The procedure is done under anaesthetic and often leads to rapid improvement. You may need to stay in hospital for a few days after.

Living with this condition

Recovery from a chronic subdural haematoma can take weeks to months. You may feel tired, have trouble concentrating, or need help with daily tasks at first. Follow your doctor’s advice about rest and gradually returning to usual activities.

Lifestyle tips

• Avoid activities that risk a fall or head bump – such as walking on slippery floors or doing contact sports.
• If you take blood thinners, talk to your doctor before starting any new medicine or supplement that might increase bleeding risk.
• Keep all follow-up appointments – some haematomas can come back and may need another procedure.
• Do not drive until a doctor has cleared you (usually after a few weeks if you had surgery).

Diet and exercise

Eat a balanced diet with plenty of fruits, vegetables, and whole grains to support healing. Avoid alcohol completely, as it can increase bleeding risk and slow recovery. Start gentle exercise like walking once your doctor says it is safe – but avoid anything strenuous until fully recovered.

Mental health and emotional wellbeing

Having a chronic subdural haematoma can be frightening and recovery can feel slow. You may feel anxious, low in mood, or frustrated. These feelings are normal. Talk to your healthcare team, family, or a counsellor if you need support. Memory and concentration often improve over time.

Prevention

You cannot always prevent a chronic subdural haematoma, but you can reduce your risk. Preventing head injuries is the best approach.

Screening programmes

There is no routine screening for this condition. If you have a higher risk (for example, if you take blood thinners or have had a recent fall) talk to your doctor about what to watch for.

Complications

If left untreated

• Worsening brain compression, leading to permanent brain damage, paralysis, or coma
• Increased pressure inside the skull (raised intracranial pressure) that can be life-threatening
• Seizures that may become harder to control
• Slowly progressive loss of mental function (dementia-like symptoms)

Long-term outlook

With prompt diagnosis and treatment, the outlook for chronic subdural haematoma is generally good. Many people make a full recovery, especially if the haematoma is drained early. Some may have long-term effects, such as mild memory problems or weakness, but these often improve with time and rehabilitation. Your healthcare team will support you through recovery.

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