How Big must Chronic Subdural Hematoma Be to Cause Symptoms?
How many millimeters–how big–must a chronic subdural hematoma be before it begins producing symptoms?
After all, if a brain bleed beneath the dura mater is small enough, it won’t cause any symptoms.
I posed this question to Charles Park, MD, neurological surgeon, Director of The Minimally Invasive Brain and Spine Center at Mercy Medical Center in Baltimore.
Dr. Park explains, “Usual rule of thumb is 10 mm.”
My mother had a chronic subdural hematoma after falling and hitting her head.
The symptoms started up, suddenly, six weeks after the accident. The CT scan revealed two bleeds: One was 15 mm and one was four mm.
Only the 15 mm collection was drained. The neurosurgeon said that the tiny collection would be reabsorbed by her body.
After the surgery, my mother’s symptoms were gone (headache and bilateral leg weakness).
Dr. Park continues, “Also, what is important is whether the [chronic] subdural hematoma will produce a ‘midline’ shift, which means that the brain is shifted to the opposite side.
“This will be a more reliable indicator for the seriousness of the SDH and a determining factor in deciding on surgery.”
On my mother’s CT scan, I clearly saw the midline shift.
Because chronic subdural hematomas that are less than 10 mm, and certainly smaller than five mm, will typically not cause symptoms, we can say that there are people who develop a chronic subdural hematoma and never know it.
These are small collections under 10 mm — and more likely under five mm—that don’t produce any symptoms and are simply reabsorbed into the body.
How are these tiny subdural hematomas even discovered in the first place?
These small collections may be discovered incidentally when the patient undergoes a head CT for another reason that coincides with the timeline of the chronic subdural hematoma.
Or, they may be detected when the CT scan is performed because the patient is exhibiting symptoms from a larger cSDH that accompanies the tiny one.
Dr. Park specializes in minimally invasive surgical techniques for treatment of conditions affecting the brain and spine. He’s skilled in advanced procedures and techniques that utilize innovative computer technology and image-guided surgery systems.
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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Top image: ©Lorra Garrick
Can Chronic Subdural Hematoma Symptoms Come & Go?
If your neurological symptoms like headache come and go, does this rule out a chronic subdural hematoma?
Let’s say you get hit in the head really hard but don’t experience any immediate neurological symptoms such as loss of consciousness, confusion or an immediate headache that worsens.
In fact, you feel fine other than the feeling that you just hit your head really hard.
You may even go to the ER to have a CT scan just in case there’s bleeding in your brain. Everything checks out normal and life goes on.
But you know all about chronic subdural hematoma—enough to worry you that in the next 90 days, there’s a possibility (especially if you’re over 65) that you’ll begin experiencing neurological symptoms due to slow bleeding in the brain over time (chronic) that was set in motion by the strike to your head weeks before.
You get a headache a week later and begin wondering, “Is this it?” But the headache never gets beyond a level 3 on a pain scale of zero to 10, and next day it’s gone.
You figure, If that was a chronic subdural hematoma, it would not have gone away.
Several days later you have another mild headache, and this time it lasts only that day.
A few days later another little headache occurs, and again, it’s temporary. (There are no other symptoms.)
And chances are pretty high that these minor headaches are not from any bleeding in your brain, but from the traumatized nerves outside of your skull, in your scalp, that took a good bang when you hit your head.
But still, you wonder:
Would the symptoms of a chronic subdural hematoma necessarily be ongoing and persistent rather than come and go?
After all, the bleeding doesn’t come and go. There’s either bleeding or there’s not.
If it’s there and causing symptoms…the symptoms will necessarily persist until the blood is surgically drained, right?
I asked Charles Park, MD, a neurological surgeon, if the symptoms of a chronic subdural hematoma can come and go.
He replied: “This is very true.” He is Director of The Minimally Invasive Brain and Spine Center at Mercy Medical Center in Baltimore.
Now realize that this article refers to chronic subdural hematoma, rather than the acute type (which is immediately life-threatening and can cause more dramatic symptoms such as projectile vomiting and stupor within hours, even minutes, of the trauma).
Dr. Park continues, “Once the cSDH develops, it will form a set of fibrous membranes to compartmentalize the cSDH.
“However, these membranes also have blood supply and it can bleed as well, adding to the cSDH already present.
“So, the symptoms can come and go as the size of subdural hematoma is gradually and incrementally increasing.”
Dr. Park specializes in minimally invasive surgical techniques for treatment of conditions affecting the brain and spine. He’s skilled in advanced procedures and techniques that utilize innovative computer technology and image-guided surgery systems.
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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Top image: Shutterstock/Dragana Gordic
Hit Head; Should You Avoid Impact Cardio to Prevent Brain Bleed?
Wondering if after hitting your head you should avoid impact exercise like running or box jumping to prevent a brain bleed?
After all, the jarring and shaking of such activity might induce bleeding in the brain if the tiny veins have already been shaken up by a strike to the head — or so it seems.
Running, jumping and similar impact exercise cause jarring to the body. The head is not excluded from some of this jarring.
If you recently got hit good in the head, you may be fearing the possibility of triggering a slow bleeding in the brain called a chronic subdural hematoma.
If you know anything about chronic subdural hematoma, you know that it’s usually caused by getting hit in the head.
The trauma shears the tiny veins in the brain. It’s understandable if you can’t help but wonder if impact exercise can accelerate leaking of blood from the veins.
“Anything that has a violent acceleration/deceleration could increase the chance of developing subdural hematoma,” says Charles Park, MD, neurological surgeon, and Director of The Minimally Invasive Brain and Spine Center at Mercy Medical Center in Baltimore.
“But in general, just running or jumping, really should not cause the bleeding.”
So if you, for instance, slipped on ice and fell backward, striking your head on the pavement, but got right back up and had no neurological symptoms, you can go running or do your jump rope or stool jumping exercises — as long as you feel perfectly fine.
Certainly, avoid these if you have any kind of neurological symptom, and instead head to the emergency room.
But again, if you feel fine, then you can do your exercises.
But you should make a point to avoid anything that puts you in a potential position of falling and hitting your head a second time — just in case you’re vulnerable to a chronic subdural hematoma.
You really don’t know with absolute certainty if you’ll go on to develop a chronic subdural hematoma or not in the 90 days following getting hit in the head.
However, if you’re younger than 60, chances are pretty small that developing one of these slow brain bleeds will ever happen.
But these brain bleeds can indeed occur in people younger than 60.
Thus, you should not feel invincible regarding a slower brain bleed just because you’re not “old.”
So during that 90 day grace period, it would be wise to avoid activities that could result in head trauma, such as horseback riding, skiing, boxing and ice skating.
But feel free to resume your running, step aerobics and plyometric (jumping) drills, as these will not spur on any subdural bleeding.
Dr. Park specializes in minimally invasive surgical techniques for treatment of conditions affecting the brain and spine. He’s skilled in advanced procedures and techniques that utilize innovative computer technology and image-guided surgery systems.
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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Top image: Shutterstock/Vadim Martynenko
Hit Head? Avoid Fish Oil & Garlic to Prevent Brain Bleed?
If you get hit in the head hard, should you avoid natural blood thinners like fish oil and garlic to prevent a chronic subdural hematoma?
I posed this very interesting question to a neurological surgeon, because it made sense to me that someone’s brain could be (for lack of a better phrase), on the fence about eventually suffering a chronic subdural hematoma.
Or maybe they are destined to develop a chronic subdural hematoma—but one so tiny that it never produces symptoms and is naturally reabsorbed by the body’s healing process.
However, what if this individual has been taking natural blood thinners, namely, omega-3 fish oil supplements and garlic?
Might these be variables that would make what could be only a five-millimeter brain bleed turn into a 15 mm collection?
Or perhaps the fish oil and garlic might cause the chronic subdural hematoma where, if this person was NOT taking natural blood thinners, would never develop the bleed.
Let us assume that in this hypothetical scenario, the person who gets hit in the head does not experience any neurological symptoms of concern at the time of injury, such as altered consciousness, loss of consciousness, nausea or visual disturbances.
Specific research on this does not exist, but here is what Charles Park, MD, explains:
“In my opinion, it will be good to avoid anything that might increase the odds of bleeding, such as any chemical blood thinners or natural blood thinners.”
Dr. Park is Director of The Minimally Invasive Brain and Spine Center at Mercy Medical Center in Baltimore.
He adds: “Even though there are no neuro symptoms, there maybe some injury to the brain, which is susceptible to further bleeding.”
So if you get hit in the head really hard, and normally take fish oil supplements or garlic supplements, play it safe by avoiding these.
Since a chronic subdural hematoma can occur up to 90 days following trauma to the head, this is the length of time you should avoid the supplements.
And it goes without saying, avoid aspirin. If you’ve been instructed by your doctor, however, to take a daily aspirin for heart health, make sure the prescribing doctor knows of your head trauma.
Don’t quit the aspirin without being evaluated by your doctor.
Discontinuing it without medical guidance can increase your risk of the conditions it’s been prescribed for, or lead to unintended health consequences.
Your doctor will evaluate your current health status, review your risk factors and determine whether continuing or stopping aspirin is appropriate for you if you’ve recently hit your head hard.
Dr. Park specializes in minimally invasive surgical techniques for treatment of conditions affecting the brain and spine. He is skilled in advanced procedures and techniques that utilize innovative computer technology and image guided surgery systems.
Lorra Garrick has been covering medical, fitness and cyber security topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She is also a former ACE-certified personal trainer.
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Top image: Shutterstock/G-Stock Studio
Young People, Chronic Subdural Hematoma but No Headache?
In younger adults, how common is it that a chronic subdural hematoma would not cause a headache?
A subdural hematoma is bleeding under the dura mater of the brain. This can begin happening several weeks to a few months after the head trauma — at which point symptoms would begin appearing.
Younger people with a chronic subdural hematoma are much more likely than elderly people to experience a headache from this condition.
This is because the younger brain has not shrunken, and thus, the space between the brain and the dura mater is very tight.
If bleeding begins occurring between this very confined space, it will create a pressure that usually results in a very bad headache.
This space is a lot bigger when the brain is shrunken (atrophied) —which usually occurs with the elderly brain.
Headache and Chronic Subdural Hematoma
“In young people, the chronic subdural hematoma is usually caused by some kind of traumatic injury to the brain,” explains Charles Park, MD, Director of The Minimally Invasive Brain and Spine Center at Mercy Medical Center in Baltimore.
Dr. Park continues, “The extent of the injury can be a mild concussion to severe contusion and bleeding into the brain and outside the brain.
“Headache is the most common symptom, but others, such as nausea/vomiting, cognitive impairment, slurred speech, visual disturbance are expected as well in that order of increasing severity.”
Summary
Headaches most commonly occur in younger people as a symptom of a chronic subdural hematoma. But younger adults can still experience other symptoms.
And likewise, an elderly person with this condition may suffer a searing headache despite more space between the aged brain and the dura mater.
The percentage of people under age 60 who have a headache resulting from a chronic subdural hematoma is estimated to be up to 80 percent.
The key words are “up to.” Data on this percentage is not exact. We cannot say, for instance, that 80 percent have headaches.
Usually, the percentage is a range that starts under 50 percent and goes up to 80.
Dr. Park specializes in minimally invasive surgical techniques for treatment of conditions affecting the brain and spine. He’s skilled in advanced procedures and techniques that utilize innovative computer technology and image-guided surgery systems.
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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Top image: Freepik.com drobotdean
Marie Callender’s Chicken Pot Pie Has TRANS FATS!
What you can’t see CAN hurt you: trans fats.
Do not buy Marie Callender’s chicken pot pies if you don’t want artery-clogging trans fats that are linked to up to 27,000 heart disease deaths every year in the U.S.
It’s BS that Marie Callender’s trans fatty chicken pot pies are made from scratch, as the company’s TV commercial implies by the aproned actress rolling dough with a pin.
These heart disease pies are made one at a time by someone’s granny in a sunny kitchen with just a handful of ingredients. NOT!
Never mind that one whole Marie Callender’s chicken pot pie contains 1,040 calories and 1,600 mg of sodium (the package lists half these values because the indicated “serving size” is HALF the pie).
- If you don’t gain body fat easily you may not care about the calories.
- If your blood pressure is always normal you may not worry about an occasional sodium tsunami.
But if you want to avoid heart disease and heart attacks, then the partially hydrogenated soybean oil in Marie Callender’s chicken pot pie should be the deal breaker.
Any partially hydrogenated fat or oil is a trans fat—and this one element is all you need for the deal breaker.
“Trans fats are man-made fats and they are commonly used in processed foods to improve the texture, flavor and shelf life of the product,” says Prajakta Apte, RDN, owner and founder of Right Nutrition Works who helps people create a healthier lifestyle.
“Many studies have confirmed that trans fats can increase a person’s risk for cardiovascular disease, stroke and systemic inflammation.”
According to the Centers for Disease Control, trans fats increase the “bad” cholesterol and may lower the “good” cholesterol.
Marie Callender’s pot pies are NOT made from scratch.
They are made assembly line style in a factory and with the toxic trans fats—in a way that would have Grandma turning over in her grave.
The Marie Callender’s site says that this product has “HOMEMADE TASTE.”
There is a big difference between homemade taste and homemade ingredients. This “homemade taste” thing is the company’s way of playing tricks on the consumer’s mind.
In the 1940’s Marie Callender began baking her pies — from scratch.
The company has grown massively since. There is NO way that each modern-day pie is carefully made from scratch — unless the company has a few million robots somewhere doing this.
Grandma needs only about a dozen ingredients to make a chicken pot pie from scratch.
Whereas the Marie Callender’s product contains dozens of ingredients including the heart poisonous trans fats and another heart harming substance, interesterified soybean oil. I bet Grandma can’t even pronounce that.
Prajakta Apte is the author of the eBook “Overcoming Nutrition Roadblocks.” Her personalized approach to nutrition therapies helps treat root causes of conditions such as type 2 diabetes, high cholesterol, GI disorders, hypertension and many more.
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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Source: mariecallenders.com/
Causes of PVC’s after Lying Down at Bedtime
Can lying down to go to sleep actually cause premature ventricular contractions?
“Most people are more aware of their heartbeat after they lie down at night, thus triggering the perception, but not the reality, of an arrhythmia,” explains cardiologist Dr. Pam Marcovitz, MD, an internal medicine cardiologist with Frankel Cardiovascular Center in MI.
This phenomenon applies to both men and women. The act of lying down at bedtime — a situation of changing body position from upright — would not disturb the heart and brain’s cardiac rhythm headquarters.
However, something needs to be said about the possibility that the moment some men and women take to their bed, their mind gets flooded with stressful thoughts.
You’re lying there in the dark and quiet, perhaps alone: the perfect opportunity for all sorts of intrusions to barge into your head, such as next-day’s tasks or an unforgivable act committed by a family member.
It can be overwhelming, reflecting upon the anticipated next-day’s struggles or someone’s outrageous behavior.
What’s going on in your life?
The phone calls you must make next day?
The people you must speak to?
The tasks you didn’t get done today that will carry over to next day?
The bills you still didn’t pay?
Anxiety mounts as you lie there in bed, and anxiety can trigger premature ventricular contractions.
In fact, your BED can be a conditioned stimulus for anxiety (because that’s where you do most of your fretful ruminating) and hence — all those PVC’s.
What Should You Do?
- Try to retrain your mind to empty all of the stressful thoughts when your head hits the pillow.
- Put on a white noise machine to help distract you from anxiety-triggering thoughts.
- Limit or eliminate caffeine intake (a trigger for premature ventricular contractions) in the few hours prior to bedtime.
Dr. Marcovitz has 40+ years of experience in helping people improve their heart health.
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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Top image: ©Lorra Garrick
TIA Headache vs. Migraine: Telling the Difference
Does a TIA headache have any features that distinguish it from migraine head pain, or vice versa?
Suppose you’re diagnosed with migraine headaches. And suppose as time goes on, you’re aware that your risk of stroke or transient ischemic attack is increasing (e.g., you’re getting older and not in the best of physical condition).
At some point you may then fear a TIA every time you have a migraine headache. Is there a way to manage this anxiety?
“Very good question,” begins Rob Lapporte, MD, who is board certified in emergency medicine.
Dr. Lapporte explains, “Some migraines can present with symptoms that are very similar, if not identical to a TIA or a stroke.
“I would say that if you commonly get migraines and the pattern changes, I would seek medical attention immediately.
“For instance, if your migraine normally consists of an aura of visual disturbances and photophobia (discomfort from light) and is followed by pain, but you suddenly develop aphasia (inability to speak or slurred speech), I would get medical attention immediately.
“If your migraine always mimics a TIA, I would talk to your doctor about getting regular screening exams, such as Doppler studies of the carotid arteries and EKGs.”
Get to Know Your Migraines
Keep a journal of your migraine headache experiences. Jot down their characteristics to identify the pattern, so that if one day you have an episode that seems different than past ones, you can refer to your notes and see if, indeed, it truly is different.
Also realize that a TIA can cause only a headache as a symptom. Carotid artery disease can cause a TIA:
A particle of plaque buildup in a carotid artery breaks loose and travels to the brain, lodging in a small blood vessel and temporarily (transiently) cutting off blood flow to the part of the brain that the blood vessel feeds into — causing the TIA.
Dr. Lapporte has been practicing evidence-based clinical medicine in emergency rooms and urgent care centers for 25+ years. His experience includes that of medical director for Legacy ER and Urgent Care.
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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Top image: Freepik/Drazen Zigic
TIA Headache vs. Ice Pick Headache: What’s the Difference?
A TIA (transient ischemic attack) can cause a really bad—and very brief—headache. And this also describes the so-called ice pick headache.
But if you keep getting stabbing, sharp pains in your head (lasting up to 30 seconds), but no other symptoms (one-sided numbness, weakness or paralysis, confusion, visual disturbance, slurred speech), the odds of all of these events being a TIA are extremely tiny.
“TIA’s usually, but not always, present with a neurologic complaint such as weakness, facial droop or slurred speech,” explains Rob Lapporte, MD, who is board certified in emergency medicine.
“Ice pick headaches occur commonly in people who also suffer from migraines and present with severe, sharp, stabbing pains in one specific portion of the head.”
However, you need not be a migraine sufferer to have an ice pick headache or sudden sharp pain in the head that lasts only seconds.
Dr. Lapporte points out that the ice pick headache lasts five to 30 seconds on average, “and are usually treated with nonsteroidal anti-inflammatories like indomethacin.”
Some ice pick sufferers have these episodes several times a day. On the other hand, some people have one or two every few months. For some sufferers, the thought of a brain tumor immediately occurs.
There is no pattern for this type of pain, and usually no trigger.
A pinched nerve in the neck can cause sharp pain that radiates to the head, and so can muscles and nerves in the neck region that have been pummeled with a strenuous weightlifting workout.
But usually, pain from a pinched nerve or nerves that are buzzed from intense weightlifting isn’t as pronounced as that of a true ice pick headache.
The key feature of the ice pick episode is that it lasts only seconds. And as mentioned, there are no other symptoms with these episodes.
Dr. Lapporte has been practicing evidence-based clinical medicine in emergency rooms and urgent care centers for 25+ years. His experience includes that of medical director for Legacy ER and Urgent Care.
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.
Top image: Shutterstock/JL-Pfeifer
Does an Untreated TIA Mean You Should Avoid Driving?
If you had an untreated transient ischemic attack, should you avoid driving, and if so, for how long?
I wondered about this, because I’ve witnessed what strongly appeared to be two TIAs of my elderly father — who denied this and thus, never sought medical evaluation and continued driving as always.
But that aside, it’s a fair question: What does it mean when a person who never received treatment for a TIA continues to drive?
“It’s usually recommended that a patient wait at least one month before getting back on the road after suffering from a TIA,” says Rob Lapporte, MD, who is board certified in emergency medicine.
A transient ischemic attack is a medical emergency.
Many people don’t realize this, believing that an emergency requires gushing blood or some other visually dramatic situation such as a misshapen leg from a broken bone.
However, a TIA is a harbinger of a stroke—and a stroke can be fatal. Stroke is the leading cause of disability in the U.S. and strikes about 800,000 Americans every year (cdc.gov/stroke/).
A TIA means that something is wrong in the person’s body, and it would be enormously erroneous to assume that a TIA is a one-time event, that it will never happen again. The second occurrence could be while the person is driving!
Dr. Lapporte continues, “That being said, anyone with a TIA or TIA symptoms (even if not officially diagnosed) should be cleared by his/her doctor before resuming activities like driving or operating heavy machinery.”
Symptoms Never to Ignore
Symptoms to be concerned about that warrant a prompt medical evaluation (ideally at an ER) are as follows:
- One-sided weakness, clumsiness, paralysis, tremoring and/or numbness, including in the face
- Slurred speech or difficulty talking
- Confusion or unresponsiveness despite apparent consciousness; difficulty understanding speech
- Blurry or double vision or what seems like a curtain coming over an eye
- Dizziness or a vertigo sensation
- Really bad headache with a sudden onset
- Difficulty with swallowing
Headache and dizziness are particularly alarming if accompanied by any of the other said symptoms.
In a TIA (or stroke), these symptoms will have a sudden onset. By definition of a transient ischemic attack, they will last for minutes, possibly seconds, though sometimes a TIA will last for a few hours.
However, when it’s only minutes and especially less than one minute, a patient is more likely to brush it off as benign, stress-related or a side effect of medication, or even something related to getting old.
Suddenly feeling as though your body is being pulled to one side while you’re walking can also mean a TIA, as is a sudden feeling of heaviness on one side of your body.
If any of these symptoms happen to you just once, there’s no reason to think they won’t happen again. Imagine what would happen if these symptoms, even just one of them, struck you while you were driving.
A prompt medical evaluation can lead to treatment that will greatly reduce the recurrence of a TIA, and hence, give your family members peace of mind when you drive!
Dr. Lapporte has been practicing evidence-based clinical medicine in emergency rooms and urgent care centers for 25+ years. His experience includes that of medical director for Legacy ER and Urgent Care.
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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