Due to their greater risk of falls due to aging, the elderly are more affected by subdural hematoma. It is a pocket of blood that forms in the brain most often following a shock, which can even be mild. But the subdural hematoma can also form gradually for other reasons.
A subdural hematoma is a pocket of blood that forms abnormally between the covering of the brain (called the dura mater) and the brain itself. There are two forms of subdural hematoma:one acute, which appears immediately after a shock, the other chronic which, on the contrary, forms gradually over several days, even several weeks, and remains well located.
Chronic subdural hematoma is the most common in the elderly. One of the consequences, in the long run, because it can grow a lot, is to compress the brain by taking up more and more space and, ultimately, cause brain damage that can be serious.
Several causes can be at the origin of a subdural hematoma in the elderly. First, a fall that results in a shock to the head, even harmless. Then, this type of hematoma most often occurs in people who take coagulants, drugs that have the function of preventing or delaying the blood from thickening, and therefore thin it.
However, these are treatments, such as aspirin for example, often followed by the elderly whose blood vessels are weakened with age. Abnormal blood clotting, especially more fluid blood caused by taking coagulants, is indeed a cause of the appearance of subdural hematoma.
Another aggravating factor for subdural hematoma is the repeated intake of alcohol.
Especially in the case of a chronic subdural hematoma, there are not really any detectable symptoms at the beginning. But, with time and the compression of a part of the brain, certain signs must alert.
These may be headaches that become increasingly strong and untimely, behavioral or memory problems, or even paralysis that is mild at first but can worsen over time. The most seriously affected patients can trigger epilepsies, or even fall into a coma.
The subdural hematoma can also cause intellectual disorders that can go as far as mental confusion.
In the case of a chronic subdural hematoma, which is more common in the elderly, there is no need to treat it urgently. In case of doubt, the doctor can, at first, decide not to intervene, or simply administer low-dose cortisone to the patient.
To follow the evolution of a subdural hematoma, the doctor can then recommend an examination such as a brain scan in order to note (or not) the presence of a subdural hematoma, its size, its position, and thus evaluate the patient's condition and make appropriate decisions regarding the treatment to be implemented, or simply decide to monitor the evolution of the hematoma.
In the event of the appearance of serious neurological symptoms, a surgical intervention consisting in opening the dura mater to let the liquid which compresses the brain pass (a trepanation) can be decided. Following an operation of this type, the subdural hematoma does not reappear in the majority of cases, especially if it was detected early.