bubble_chart Overview

Chronic subdural hematoma refers to intracranial bleeding where blood accumulates in the subdural space, with symptoms appearing more than three weeks after the injury. Currently, there is no unified understanding of the source of bleeding or the pathogenesis of the hematoma. It accounts for approximately 10% of intracranial hematomas, often occurring in the convexity of the frontal, parietal, or temporal hemispheres, with a blood volume ranging from 100 to 300 milliliters. The clinical presentation is primarily characterized by increased intracranial pressure, with headache being particularly prominent. Some patients may exhibit psychiatric symptoms such as dementia, apathy, and intellectual impairment, while a few may experience focal neurological symptoms like hemiplegia, aphasia, or focal seizures. The disease follows a chronic course, and timely diagnosis and surgical intervention generally yield satisfactory outcomes. Poor outcomes or fatalities are typically due to delayed diagnosis and treatment, critical illness, or associated complications.

bubble_chart Clinical Manifestations

1. Symptoms of increased intracranial pressure: headache, vomiting, optic disc edema. Infants and young children often experience convulsions, vomiting, feeding difficulties, bulging anterior fontanelle, and increased head circumference.
2. Mental disorders: dementia, apathy, memory decline, disorientation, and intellectual retardation.
3. Focal brain symptoms: hemiplegia, numbness, aphasia, and focal epilepsy.

bubble_chart Diagnosis

1. There is often a history of minor head injury or overlooked trauma, with symptoms typically appearing more than 3 weeks after the injury.
2. Symptoms of chronic intracranial hypertension such as headache, vomiting, and optic disc edema; infants may experience convulsions, vomiting, bulging anterior fontanelle, and increased head circumference. In advanced stages, brain herniation may occur. Some patients present with prominent psychiatric symptoms or focal neurological deficits.
3. Head X-rays often show signs of chronic intracranial hypertension, with a few cases exhibiting calcification of the hematoma. In cases of supratentorial hematoma, ultrasound may reveal midline shift to the opposite side. Cerebral angiography, head CT, or MRI can determine the location and extent of the hematoma.
4. Exploratory burr hole reveals subdural hematoma.

bubble_chart Treatment Measures

1. Surgical treatment: Closed drainage via cranial burr holes; infants may undergo anterior fontanelle puncture drainage.
2. Symptomatic supportive treatment.

This disease is commonly seen in the elderly and infants under 6 months of age. If symptoms such as headache, vomiting, mental disturbances, or focal neurological signs gradually appear after a period (more than 3 weeks) following a head injury, this condition should be considered, and prompt consultation with a specialist is necessary. For patients without a history of head injury or infant patients, it can sometimes be clinically challenging to differentiate this condition from intracranial tumors or congenital hydrocephalus. However, CT, MRI, or cerebral angiography can provide a definitive diagnosis. Surgery is the optimal treatment method, and most patients who undergo timely surgery have a favorable prognosis. For postoperative patients who experience recurrent symptoms or poor outcomes, a CT re-examination should be performed.

bubble_chart Cure Criteria

1. Cure: Hematoma disappears, symptoms and signs disappear, normal life and work are restored.
2. Improvement: Hematoma disappears, symptoms improve, but neurological dysfunction remains, self-care is possible, with some work ability or partial loss of labor capacity.
3. No cure: Hematoma does not completely disappear, symptoms and signs show no improvement, and self-care is not possible.