Chronic subdural haematoma in the elderly: Falls as an underestimated cause

– The information has been reviewed by Dr. Chan Chun Chung

Elderly people experiencing falls should never be taken lightly, even when there is no apparent head injury. It is because bleeding might have already occured in the dura mater, which could damage the brain. Even if the force of a collision is not strong, such as bumping heads during a car ride when a car suddenly brakes, there is still a chance of causing brain trauma. Family caregivers must pay close attention to their elderly family members to prevent severe problems from developing.

No bleeding, no injury?
No bleeding, no injury?

When an elderly person falls, even if there is no apparent bleeding in the head, it is important to pay attention to whether there is bleeding in the brain.

Head injuries can be categorized into acute and chronic, and chronic subdural hematoma is more common in the elderly population. It refers to an internal brain injury with a slow collection of blood (hematoma) between the skull and the surface of the brain. The symptoms are often not obvious, and the injury may not be detected even with a computed tomography scan.

In most cases, when the symptoms become apparent, the bleeding has already occured for a while and the blood has clotted, which compresses a part of the brain and causes a temporary loss of brain function.

How to look out for chronic subdural hematoma in elderlies
How to look out for chronic subdural hematoma in elderlies

A head injury can worsen any time between a few weeks to a few months after the injury happens. The following minor symptoms should not be taken lightly:

  • Headache, dizziness, vomiting, blurred vision, and ringing in the ears
  • Numbness and incoordination of the limbs
  • Confusion, slow thinking, and memory loss
  • Trouble with speech
  • Short-term epilepsy

Older adults tend to have lower sensitivity to pain; they may not exhibit symptoms such as vomiting, dizziness, and headaches when they sustain a head injury. Therefore, if an older person has a head injury, it is recommended that they consider receiving a CT scan based on their age and coma index, regardless of whether they have an apparent head injury.

Why are elderly people more likely to develop chronic subdural hematoma?
Why are elderly people more likely to develop chronic subdural hematoma?
  • Most elderlies need to take blood-thinning medication due to illness, hence the higher risk of bleeding in the brain.
  • The brain often shrinks with increasing age due to degeneration, leading to extra space for the blood to accumulate when bleeding occurs. That's why symptoms don't appear immediately after a head injury. However, when the blot clots absorb water and expand during the dissolution process three to four weeks after the injury, the intracranial pressure will increase, causing various symptoms to appear.
  • Elderlies are more likely to have poor memory. They are prone to having head injuries without realizing it, leading to severe problems if not treated in time.
How long does it take to know if an elderly person is fine after an asymptomatic head injury?
How long does it take to know if an elderly person is fine after an asymptomatic head injury?

Bleeding from head injuries usually occurs within 6 hours of the accident, and swelling and other problems can appear within 24 to 48 hours. Therefore, if the head injury occurred several weeks or even months ago, family members can rest assured that their elderly members don’t have any blood clots in their brains.

How to treat brain injuries in elderlies?
How to treat brain injuries in elderlies?
  • Since hematoma will increase the intracranial pressure and may damage brain cells, surgery is required to have the blood clot removed or drained.
  • During the surgery, two holes will be drilled into the skull to drain the haematoma. This treatment method has a high success rate and does not cause permanent damage to the brain. Patients can generally have a speedy recovery, and their speech and mobility will return to normal.
  • However, about 10% of patients will have new blood clots formed in the brain after surgery.
  • In addition, patients with heart disease or who have had a stroke are at higher risk of recurrence due to prolonged use of aspirin or other anticoagulant medications. It may slow down the healing of the holes drilled into the skull and may cause new blood clots to form in the wounds.
How to prevent falls in elderlies?
How to prevent falls in elderlies?
  • Remind your elderly family members to wear non-slip footwear.
  • Elderlies should use walkers, quad walking canes, or walking sticks to aid their walking.
  • Keep home walkways clear and well-lit; use non-slip carpet on kitchen and toilet floors and install handrails.
  • Encourage elderlies to do more exercises that can help strengthen their muscles and make them better at coordination and balance, such as Tai Chi.

If elderlies have head injuries, family members must pay close attention to see if they develop any symptoms to prevent intracranial pressure from going too high, leading to sequelae.

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