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?
Written by
TWF64
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Hi TWF. Sorry, but these are highly technical issues which only medically trained neuro experts can explain, especially as each brain is unique, as are our medical histories.
We support each other here by comparing notes on the aftermath of our brain injuries, whether acquired by trauma or illness, and offering practical and emotional support.
But for competent advice please contact the Headway helpline on tel. :-
Highly medical. I think sometimes when the consultants use these terms they forget that real people don’t have their insight.
You seem to have a fair understanding of what could be underlying acute on subacute, etc. That explains the current but not the cause as you know. Unfortunately there are still many unknowns which only the consult and/or more tests can answer. Frustrating, but true.
If you have had endoscopic surgery and only partially sorted as it sounds, there may be an only partially sealed or failed vessel? Hard to tell. I can only speak from my experience.
Originally my bleed was from an AVM rupture and now 5 years on I cannot have additional endoscopic surgery as the vessels are no longer viable due to previous gamma surgery degrading them.
The burr hole is another issue. I had an emergency one to relieve pressure on the ventricular 5 yrs ago. It healed well and my hair has regrown to cover it. It’s really dependent on area and what it’s trying to achieve - again the Consultant has the clues!
As far as living with it after - I’m wary as I have a hole in my head! The hair has regrown but I hate going to the hairdresser or anyone touching it and I am self conscious definitely. The area feels both numb and highly sensitive at the same time! Again, this is highly personal so you might find it very different!
There are no clear answers, but as Cat said - the experts can give us a bit more clarity hopefully!
hello, i also had 2 bleeds. I was different to you in that I had many symptoms and became very ill over a 3 month period and eventually led to collapse and hospital admission where the scans found the 2 brain bleeds. I had burr hole and craniotomy for one side of my head for one bleed. The other bleed was smaller and they scanned me 2 days later to see if I needed another surgery. I did not need it, it was absorbing well. It was explained to me that the absorption depends on the size, density and location. They can tell what it old blood (chronic bleed) and new blood (acute bleed). In my case, I think one had stopped bleeding and the other did not. I follow your logic.
I met my consultant some weeks after i was discharged and asked questions. I remember him stressing that blood vessels in the brain age, get thinner and break and cause brain bleeds. I was only 51 and surprised by this at my young age! I was given precautions not to be involved in anything that impacted my head. I had had an accident at home and banged my head so I was not expecting to receive this information. I am not sure if this information was relevant to my scan, it seemed to me he was speaking in general and he was concerned that care should be taken moving forwards.
I have just checked my head to see if there is a larger dent from my burr hole, done 22 months ago. Upto now I have only noticed bumps on my head from the craniotomy metal staples and nothing from the burr hole. I cant feel a dent but i'm unsure where the holes were. I think there were 2? I can say that the tube filled up a large sized bag of blood over 3-4 days (husband tells me) and husband says I felt good seeing it evacuate my head because I had been so ill prior to surgery!
It was so much easier for me as I was taken in as an emergency and operated on. I think you are in a difficult position having information but not feeling confident with your understanding and needing to make a decision. I would hate to be in that position! Cat has suggested you phone Headway. They will be able to give you specific information from your description. You will have a good understanding of the nature of the bleeds and of the burr hole procedure. Hopefully this will help you to make a decision. It must feel so surreal to have to make this type of decision. The headaches are natures way of telling you something isn't right. The question is, will the bleeds resolve themselves or not. Headway cannot answer that with certainty but their advice will hopefully give you knowledge to make the decision.
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