You may already know that a chronic subdural hematoma can cause permanent physical disability.
But what about an increased risk of Alzheimer’s disease?
Can the bleeding that contacts the brain set in motion a chain of biochemical events that ultimately lead to the development of Alzheimer’s disease or some other form of dementia?
A chronic subdural hematoma is a gradual or slow bleeding in the brain that occurs over weeks, following some type of trauma such as hitting one’s head on a car door frame, a slip-and-fall or a whiplash injury that jars the brain.
A cSDH is far more likely to occur in elderly people because, due to age-related brain shrinkage, there’s more room between the brain and dura, making it easier for veins to be torn.
However, it can also happen from head trauma to people in their 50s and 60s.
Blood thinning drugs, too, can cause a cSDH in elderly people.
Symptoms of Chronic Subdural Hematoma
The symptoms resemble those of a stroke and include cognitive impairment.
The patient won’t have all the possible symptoms since symptoms depend on the location of the bleeding.
However, a gradual onset of what seems like early Alzheimer’s can definitely be a symptom in an elderly person who, several weeks prior, banged their head from a fall or even just “nicked” it on an open cupboard door.
In fact, sometimes the diagnosis is highly suspicious for dementia —until a CT scan reveals the bleeding.
So on one hand, it’s accurate to say that a chronic subdural hematoma can cause symptoms mimicking dementia or Alzheimer’s disease.
But once the collection of blood and fluid is drained via a burr hole procedure, the patient usually has a full recovery. The “dementia” was temporary.
But is it possible for this insult to the brain tissue to raise the risk of future development of Alzheimer’s disease?
”Chronic subdural hematoma is very common in people within the older age group,” says Dr. Urvish K. Patel, MD, MPH, a research associate in the Department of Neurology at Creighton University School of Medicine/CHI Health.
“Due to an ageing population, chronic subdural hematoma is projected to become the most common adult neurosurgical diagnosis.
“Due to oxidation-reduction reactions in chronic subdural hematoma and exerting its effects using cytokines and inflammatory mediators, cSDH leads to neurotoxicity and inflammation-related brain atrophy.
“In such circumstances, it increases the risk of Alzheimer’s disease and dementia.”
Causes of Alzheimer’s Disease
In under five percent of cases, a genetic variant that’s present since birth will lead to the disease, though the mechanism is not known.
In the remaining 95 percent of cases, nobody knows just what exactly causes Alzheimer’s. What’s known, however, is what it’s associated with.
• Plaques. It’s believed that the presence of beta-amyloid plaques kills brain cells, but again, the mechanism of cell death is not known.
• Tangles. A protein called “tau” is key to the system of support and transport of nutrients to brain cells.
In the brains of Alzheimer’s patients, tau protein is tangled up inside brain cells, crippling the system.
Commonly Known Risk Factors for Alzheimer’s
• Age 65+
• Immediate family member has the disease.
• MCI: mild cognitive impairment in older age that’s more than what would be expected for that age.
• History of severe head trauma (e.g., car accident, ladder fall).
• Lack of exercise
• Obesity
• High cholesterol
• High blood pressure
• Smoking
• Poorly managed type 2 diabetes
• Lack of vegetables and fruits
• Sub-high school education level
Age-related changes in the brain are also suspect as causative factors in Alzheimer’s. These include:
• Brain shrinkage
• Inflammation
• Free radicals
• Breakdown of a cell’s energy production
Delayed Treatment of a Chronic Subdural Hematoma
This heightens the chance of permanent deficits, as was the case with a 60-something man at my gym who was initially misdiagnosed a month after he fell and hit his head, then finally properly diagnosed a month after that.
By then the continuing buildup of blood and fluid in his brain had caused irreversible damage to the right side of his body — but left him cognitively intact.
A cSDH can be missed on a CT scan.
For optimal brain health, one should avoid the modifiable associated risk factors with Alzheimer’s.
Dr. Patel’s
