Elderly age plus head trauma = fair chance of developing a chronic subdural hematoma, and this chance jumps when the elderly individual is on the blood thinner Coumadin at the time of their fall.
“It has long been recognised that the elderly are more likely to develop subdural haematoma, particularly from minor trauma,” states the Postgrad Medical Journal (2002, Vol. 78). This is because, continues the PMJ, brain shrinkage and increased frailty of the brain’s veins are associated with aging.
“With aging, the mass of the brain decreases leading to an increase in the space between the brain and the skull from 6% to 11% of the total intracranial space,” states the PMJ. As a result, the bridging veins stretch.
The brain can move more due to the increased space, and this makes these veins more vulnerable to tearing from getting hit in the head or hitting the head from a fall.
These are point blank medical facts, so why don’t ER doctors warn elderly patients (who have a normal CT scan following a fall or other hit to the head) to be on the lookout for neurological symptoms in the weeks to come? That is, neurological symptoms of a chronic subdural hematoma — especially if they’re on Coumadin?
My elderly mother had a normal CT scan, and then another 24 hours after that, following a fall and visible injury to her head. I asked the ER doctor, “What about the chance that a few months down the road, there’s bleeding in her brain?” The doctor said, “There’s a very slim chance of that.”
According to the PMJ, the chance certainly doesn’t sound “slim.” Six weeks later my mother awakened with a searing headache and significant lower body weakness, out of the blue. A CT scan later in the day showed a chronic subdural hematoma. At the time of her fall, she still had Coumadin in her system (she’d gone off it the day prior).
The original ER doctor had known she was on Coumadin. This ER doctor never told my elderly mother about the blaring risk factors for a chronic subdural hematoma: hit on head (it’d even been bloodied), elderly age, and Coumadin.
Recently my father had an apparent blackout (he can’t remember the preceding moments) while standing, and fell face down. He’s elderly. He was on Coumadin. The fall resulted in a “goose egg” purple and red swelling on his forehead (called a hematoma, actually — “hema” is the medical prefix for blood, and “oma” refers to mass).
Nobody at the ER informed him that there’s a fair chance that a few weeks or months down the road, he will develop symptoms from a chronic subdural hematoma. The PMJ notes that, indeed, neurological symptoms may not present for “weeks to months” after a fall or other head trauma, even seemingly mild — mild enough to forget about it, even.
“The CT scan is normal,” was all my parents got. Because elderly patients typically do not get a warning about chronic subdural hematoma, they and their family often don’t have a clue what’s going on weeks later when the neurological symptoms start developing.
The PMJ says that the neurological symptoms of a chronic subdural hematoma can mimic dementia, stroke and transient ischemic attack. They can also mimic psychiatric disorders, especially in a person with a pre-existing psychiatric issue.
If you’re elderly (or know someone who is) and have recently hit your head, and the CT scan was normal, even one 24 hours later, consider the next few months as an incubation or grace period for the development of a chronic subdural hematoma.
More on chronic subdural hematoma:
-Can untreated chronic subdural hematoma be fatal?
-Can chronic subdural hematoma with symptoms resolve on its own?
-Symptom comparison: chronic subdural hematoma vs. stroke
Source: pmj.bmj.com/content/78/916/71.full
