Chronic Subdural Hematoma in Elderly: Most Common Symptoms
The most common symptoms of a chronic subdural hematoma in the elderly differ than those in younger patients. A subdural hematoma is bleeding between the brain and dura mater, and the chronic version means this situation begins showing symptoms at least a few weeks after the head trauma (which in elderly people, may be quite trivial).
The Postgrad Medical Journal (2002, Vol. 78) provides an extensive list of symptoms pertaining to chronic subdural hematoma in the elderly, beginning with the most common.
Altered Mental State
“The most common presentation is altered mental state,” says the PMJ. This occurs in 50-70 percent of patients. My elderly mother had a chronic subdural hematoma twice: the initial one and a recurrence about 10 days later.
Her mental state with the first one seemed normal, though it was odd that she wasn’t alarmed over her severe leg weakness. Her mental state with the recurrence was altered: a mild level of impaired reasoning.
The PMJ list includes confusion, drowsiness and acute delirium. As my mother’s recurrence unfolded, she developed acute delirium, but the ER doctor attributed this to an adverse reaction to the Medrol Pak (oral steroid drug to reduce brain inflammation). Coma is another possible symptom of chronic subdural hematoma in the elderly.
Focal Neurological Deficit
This is the next category of most common symptoms of chronic subdural hematoma in elderly patients. One study, as reported in the PMJ, found that 58 percent of elderly patients suffered weakness on one side of the body. My mother had it in both legs.
The PMJ says, “Fluctuating neurological symptoms are uncommon.” My mother’s significant leg weakness never remitted prior to treatment. However, it’s not known how insidiously it developed because at around 7 a.m. that morning, she reported feeling normal when she arose to use the bathroom. She returned to bed and around 10:30 a.m. got up, and that’s when a mobility problem was quite obvious.
Headache
Headache incidence varies from 14-80 percent depending on the study, says the PMJ. My mother’s initial occurrence included a “crown of thorns” headache. Though headache is the third category of likeliness of symptoms reported in the PMJ, a headache is a less common symptom in the elderly than in younger people with chronic subdural hematoma.
Falls
A study of 43 elderly patients found that falls occurred in 74 percent, notes the PMJ report. Ironically, falling as a symptom of cSDH can make the cSDH worse. Falls as a symptom may result from neurological deficits, altered mental state or postural disturbances.
Seizures
Seizures are a rare symptom of chronic subdural hematoma, though patients with pre-existing epilepsy may have increased seizure activity with a cSDH. A chronic subdural hematoma can produce a simple partial seizure as its only symptom. This can mimic a transient ischemic attack.
Transient Neurological Deficits
The PMJ says the incidence of TNDs is 1-12 percent. In the elderly the most common TND symptom from chronic subdural hematoma is one-sided paralysis or numbness. There’s been at least one case reported of on-and-off partial paralysis of the lower limbs due to a cSDH on both sides of the brain.
Rare Symptoms of Chronic Subdural Hematoma in Elderly
Vertigo; fast, uncontrollable eye movements; tremoring (Parkinson’s-like); right-left disorientation; unawareness of one’s fingers; inability to write; inability to do simple math; and slowly tilting towards a fall without making postural adjustments due to unawareness of this.
My mother’s recurrence of chronic subdural hematoma produced a most intriguing symptom: left side neglect. A person with severe left side neglect may refuse to believe that their left leg and arm are theirs. My mother would make right turns when told to go walk left, and would try to pick things up with her left hand and miss the object, yet think she had it in her hand! Read more about this here.
