What is CHRONIC SUBDURAL HAEMATOMA?

Our guest is Dr Mrs Opara. A consultant Neurosurgeon. Neurosurgery is an aspect of surgery that is concerned with SURGICAL TREATMENT of patients with injury to, or diseases/disorders of the brain, spinal cord and spinal column, and peripheral nerves within all parts of the body.

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Like most people would say, it is the most difficult aspect of Medicine with most of their surgeries lasting over 24hours. We’ve 95 Neurosurgeons currently in a population of over 200million.

She is someone I really look up to, she’s young, beautiful, eloquent and she makes you just want to fall in love with Neurosurgery. She’s an inspiration to me.

Today I’m honoured to have her as our guest. Neurosurgery is the busiest speciality and having her squeeze out time to grace this interview is something I will forever be grateful for.

She will be talking on CHRONIC SUBDURAL HEMATOMA. I chose this topic because it is quite common in our environment yet, the awareness is almost zero.

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Let me share this story…

A 65 yr old man hit his head on the wall while leaving his room. It was a minor trauma and so he went about his daily activities. Three weeks later, he left his house and on his way way back home at night he started feeling drowsy and confused.

Guess what he did? He parked his car on the road side, locked it up and laid on top of it. He slept there. Meanwhile his family was worried, called his phone countless times with no response only for him to be found sleeping on top of his car. Strange right? Following change in his behaviour, he was taken to different places before he was finally diagnosed of having Chronic Subdural Hematoma. He was referred to Neurosurgeon and had his surgery done.

Today he is alive and healthy going about his activities. Guess what would have happened if he wasn’t diagnosed? Your guess is as good as mine…

What is Chronic Subdural haematoma

A condition in which there is a collection of blood under the covering of the brain that has been there for a while. Brain has 3 coverings…PIA ARACHOIND and Dura. Dura is directly under the skull. When there is collection of blood under the dura it is called Subdural haematoma.

When is our said to be a Chronic Subdural Haematoma?

When the accumulation is more than 3 weeks- Chronic Subdural haematoma, acute , 3days-3weeks subacute

Epidemiology

It is more common in elderly patients, those above the age of 60yrs

It can be found in either of the sexes, however trauma seems to be more in Males gender, so there is slight Male preponderance.

Causes

Quite a number of things have been associated with it. Most cases of chronic Subdural, there is some history of trauma to the head which is usually minor. Like someone hit his head on the wall while leaving his room, fall on the floor, usually not associated with loss of consciousness.

There is shrinkage of the space between the dura and the rest of the brain. The dura becomes more intimately adherent to the bone. Some bridging veins that course from the surface of the brain to the Subdural space to link up with the veins within the bones called Diploic veins. These veins become more fragile as one ages. The combination of these two factors make it easy for the coins to rupture if there is a minor trauma to the head.

They rupture and begin to sip blood gradually into the SDS. It takes a while before the symptoms begin to manifest usually due to pressure in the brain or irritation of the area the bleed is.

Risk factors

• Old age usually above 60yrs
• Diabetes mellitus
• Hypertension
• Clotting disorders like hemophilia
• Some medications like blood thinners

Diagnosis

Usually from the history and symptoms. Symptoms are myriad. Could range from just having headache, down to changes in mental status (ie the degree to which one’s active and alert being more drowsy, sleepy than usual etc)

• Headache
• Abnormal behaviour
• Weakness on one side of the body
• Seizures

Image guidance diagnosis is done with CT-SCAN which shows a collection of blood in the Subdural space. Below is a CT-SCAN of a normal brain (R) and one with chronic Subdural haematoma (L)

Once diagnosis is made, patient must be referred urgently to a Neurosurgeon.

Treatment

Treatment is by surgery, unless it was an incidental finding and not symptomatic

Complications

Complications of non treatment is worsening clinical state.

Recurrence

Infection

Prognosis

The prognosis is almost excellent It has a beautiful outcome when detected on time.

Advise for the General public

Any complaints that has to do with the brain like chronic headaches that is not responding to paracetamol , or noticed abnormal change in behaviour and/ or in sleep pattern in an elderly person. See a Doctor so it can be diagnosed early. Not all abnormal behaviour is old age related. And once a diagnosis of Chronic Subdural Hematoma is made, ensure you’re referred immediately to a Neurosurgeon.

Thank you ma, I’m sure the readers have a lot to take home after reading this. We appreciate