What are the signs and symptoms of chronic subdural hematoma (SDH)?

Updated: Jul 26, 2018
  • Author: Richard J Meagher, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Clinical presentation for chronic subdural hematoma is often insidious, with symptoms that include the following:

  • Decreased level of consciousness

  • Headache

  • Difficulty with gait or balance

  • Cognitive dysfunction or memory loss

  • Personality change

  • Motor deficit (eg, hemiparesis)

  • Aphasia

Chronic subdural hematoma may have a presentation similar to that of Parkinson disease. [25, 26] An acute presentation is also possible, as in the case of a patient who presents with a seizure.

Headache and confusion appear to be the most common presenting features, occurring in as many as 90% and 56% of cases, respectively. In 75% of cases, the headache had at least one of the following characteristics:

  • Sudden onset

  • Severe pain

  • Accompanying nausea and vomiting

  • Exacerbation by coughing, straining, or exercise

Other common symptoms include weakness, seizures, and incontinence.

Hemiparesis and decreased level of consciousness are common, occurring in approximately 58% and 40%, respectively. Hemiparesis was ipsilateral to the hematoma in 40% of cases in one series. Gait dysfunction is another common finding.

When signs of chronic subdural hematoma in different age groups are compared, somnolence, confusion, and memory loss are significantly more common in elderly patients (aged 60-79 y). Signs of increased intracranial pressure (ICP), such as headache and vomiting, are more likely to be seen in younger patients. Fluctuating signs or symptoms occur in as many as 24% of cases.

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