Chronic subdural hematoma can occur spontaneously and being elderly is perhaps the No. 1 risk factor for developing this condition.
It is not to be confused with acute subdural hematoma from a car accident, skiing accident or other significant blunt force trauma to the head.
My mother developed a chronic subdural hematoma as a result of striking her head on the bathtub after passing out while standing at the sink – from a drop in blood pressure.
Her neurosurgeon informed me that chronic subdural hematoma was “not uncommon in the elderly,” and that it can occur “spontaneously” due to weakened bridging veins, and brain atrophy.
If elderly people take daily aspirin or other anticoagulants, this increases risk even more.
So based on my conversation with my mother’s neurosurgeon, spontaneous chronic subdural hematoma in the elderly is far from a rare occurrence, and this made me wonder why there’s no media attention to this.
I never heard of this condition until my mother developed it, and I write medical articles for a living.
I receive Kaiser Permanente’s monthly magazine which highlights common conditions of the elderly (diabetes, heart disease, osteoporosis, osteoarthritis, dementia), but never have I seen anything on spontaneous (or otherwise) chronic subdural hematoma.
Kangmin Lee, MD, says that the occurrence rate of spontaneous subdural hematoma, compared to non-spontaneous causes such as getting hit in the head or heavy drinking, in the elderly is 30 percent.
This sounds like a lot.
“Thirty percent seems like it would be fairly common,” continues Dr. Lee, a neurosurgeon with New Jersey Brain and Spine.
“However, the overall incidence of chronic subdural hematoma in the entire population is approximately one to five per 100,000.
“So it would be 30 percent of that number (the one to five) that would fall into the spontaneous cSDH number.
“With respect to other medical issues such as heart disease and cancer — it is less common. However, as our elderly population continues to grow in number, we will likely see the incidence numbers start to rise.”
The elderly are particularly prone to falling, either due to weakened hip bones, general leg weakness, transient ischemic attacks, and miscellaneous factors such as orthostatic hypotension (plummets in blood pressure after standing from a seated position that can cause a blackout).
The elderly are also more likely to be on anticoagulant therapy, like my mother was (daily aspirin and Coumadin at the time she fell), after undergoing coronary bypass surgery (as did my mother).
And then there’s the age-related brain shrinkage.
Combine these factors, and it would not be accurate to say that chronic subdural hematoma is rare in the elderly population, but more accurate to say that spontaneous chronic subdural hematoma in the elderly (patient has no risk factors other than old age) isn’t particularly prevalent.
Dr. Lee focuses on minimally invasive techniques to treat traumatic and degenerative diseases of the spine and brain tumors. He’s been invited to speak at the regional and national levels on his research areas.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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