Spontaneous Subdural Hematoma

[TWF64]

I am 58 years old. A few months I started to develop headaches and neck pain that gradually increased in severity. I eventually went to the ER and was diagnosed with a minor subdural hematoma (SDH) based upon a CT Scan and was sent home for follow-up with a neurosurgeon. I have had no recent head trauma. The only symptom I have had is headaches with no issues with gait, vision changes, confusion, mood changes, numbness, etc.

Subsequent CT scan in September 2023 showed a subacute bilateral hematomas 4-5mm in size with a 4mm midline shift. A MRI a couple of weeks later showed the hematoma on the right side increased in size from 6mm to 12mm. There was also some minor flattening of the brain visible.

Since my headaches were initially positional and essentially non-existent when I layed down, my neurosurgeon suspected a CSF leak. A blood patch and a embolization of a suspected fistula in my back were performed. This seemed to help a bit, but did not resolve my headaches.

My headaches are continuing, but they no longer positional as they are no longer relived by lying down.

Based upon this, an MMR embolization was performed. Two weeks after the embolization, a follow-up CT scan showed the SDH on the left side was essentially resolved, but the SDH on the right side was unchanged in size. The midline shift has reduced from 4mm to 2mm.

The CT report showed the SDH on the right side as acute on subacute. Another CT scan two weeks later showed no change in size, but noted varigated density and slightly increased density.

I am unclear why the 4-5 mm SDH on the left side appears to have resolved itself while the size of the SDH on the right side has remained the same.

My understanding is that the fact that the SDH was initially "subactute" but is now "acute on subactute, " along with the slightly increased density would indicate that there has been more than one episode of bleeding. I am thinking that, despite the MMR embolization, since the size of the SDH has remained unchanged but is now acute on subacute, perhaps this indicates that bleeding may be continuing at a rate that matches the reabsorption of the blood. Does this sound logical?

My neurosurgeon is now suggesting the possibility of a burr hole surgery to vacate the SDH. I am concerned about the burr hole surgery and the large scar or depression that may be left from it. Of course, my health takes priority over this. I don't know if the burr hole surgery may be overcautious at this point, or if it may be better to continue to monitor the SDH to see if it starts to show signs of improving before performing the burr hole surgery.

My understanding is that a 12mm hematoma is considered large. However, as I have mentioned, I have no symptoms other than headache. My neurosurgeon explained to me that the lack of symptoms may be due to the fact that the SDH occurred slowly over time, and the body has adjusted to it.

My case appears to be very unusual in that the SDH is spontaneous and large, which is not common for someone of my age. I rarely drink alcohol, have never done drugs and am not any blood thinner medications.

I have many questions, but my main ones are as follows:

1.) What might explain why it appears that the SDH on one side has resolved itself while the SDH on the other side has increased in size?

2.) What might explain the spontaneous nature of the SDH?

3.) Should I try to avoid a burr hole surgery at this time and just have the SDH monitored closely before this is done?

[Leaf100]

hi TWF64

Your questions are very specific, and no one here can give medical advise.

Your best bet is to call Headway, the help line link is posted on your right.

I will say that any surgical intervention feels really scarey, especially if you haven't had it anything done before.

I am in no way an expert, though I would say my experience with medical people is they often 'wait and see' quite long enough. Talk it over with Headway.

I can also say that around 30 years ago, when medicine wasn't as advanced as now, my retired neighbour had 2 holes done in his skull, and it helped him a lot. I couldn't see where they were. And these days, they are so much better at all this kind of thing.

May I ask if it really the scar that is bothering you, and not , well, the unknown and so much at once? I am wondering if you have had any counseling and perhaps Headway could suggest someone or some program - what you are going through is a lot for anyone.

Take good care, give Headway a call, and keep us posted.

Leaf