Chronic Subdural Hematoma: Symptoms, Diagnosis, and When Surgery Is Warranted

It is a scenario encountered regularly in clinical neurosurgery: an older relative or an individual taking blood-thinning medication has a mild, almost forgotten bump to the head—such as hitting their forehead on an open cupboard door. Weeks later, family members notice subtle forgetfulness, dragging of one foot, or increased sleepiness.

Frequently, these symptoms are mistaken for accelerated dementia or a small ischemic stroke. However, a simple non-contrast head CT scan reveals the true cause: a chronic subdural hematoma.

Recent scientific research—including investigations into inflammatory biomarkers published in international neurosurgical literature—has demonstrated that chronic subdural hematomas are not just passive puddles of stagnant blood. They are dynamic, actively inflamed collections lined by fragile capillary membranes that repeatedly leak fluid and inflammatory cells.

Understanding this inflammatory component is transforming how surgeons approach postoperative care, helping to predict which patients are at higher risk of recurrence.

When a hematoma produces significant midline shift or neurological impairment, surgical drainage via one or two small burr holes is a remarkably effective and gentle intervention. The liquefied collection is irrigated, and a soft temporary drain is placed to allow the brain to re-expand.

Patients and families often witness striking improvements in alertness and strength within 24 to 48 hours of fluid evacuation.