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Subdural Hematomas

I’ve recently become aware of how much our elder population, among others, is at risk for the development of subdural hematomas.  These are a form of brain injury, in which tears develop in the small blood vessels surrounding the brain.  As they hemorrhage, the pooling blood can cause pressure on delicate brain tissue, ranging from life-threatening to relatively minor.  However, even the most minor of these has the potential to cause disruption in brain function.

The aging population is at greater risk for the development of subdural hematomas, for a few reasons.  Firstly, as the brain ages it tends to shrink.  The spaces that are bridged by the blood vessels increase in size, making those vessels more vulnerable to damage.  Too, the elderly have veins that are more brittle than those of younger persons.  If the person is taking medication to thin the blood, that only makes the risk that much more severe.

This is significant because the elderly are at a significant risk for falls.  We’re well aware of the risk of broken bones, but many aren’t aware that the brain is just as liable to be injured in a fall.  A broken hip, or arm, is easily seen.  A minute bleed in the brain is not as visible.

Here are some of the signs and symptoms that tell us we should look for a possible subdural hematoma:

  1.  History of recent head injury
  2. Loss of consciousness or fluctuating level of consciouosness
  3. Irritability
  4. Seizures
  5. Pain
  6. Numbness
  7. Headache
  8. Dizziness
  9. Disorientation
  10.  Amnesia
  11. Weakness or lethargy
  12. Nausea or vomiting
  13. Loss of appetite
  14. Personality changes
  15. Slurred speech or inability to speak
  16. Difficulty walking
  17. Altered breathing patterns
  18. Hearing loss or ringing in the ears
  19. Blurred vision
  20. Abnormal eye movements, or deviated gaze

It may be noted that some of these signs are also seen in persons with dementia.  But that fact only makes it more important that we watch out for the development of such things, and take steps to investigate their cause when they do occur.  Unfortunately, there are a good many people who have been misdiagnosed as having dementia, when they in fact have a head injury.  The treatment of these two disorders, and their prognosis, is often quite different.

It’s easy to assume, if a person with dementia has a change in consciousness or becomes more irritable than usual, or suddenly is harder to understand, that they’re merely experiencing a natural progression of their dementia.  Or we find that a person who shows up in the emergency room with the same symptoms is given a new dementia diagnosis.  But are we too quick to make such judgments?

What if that same person with dementia, a resident in a long-term care facility, is also having trouble keeping food down, or acts as if she is having more trouble than usual seeing or hearing?  Or suddenly is more unsteady on her feet, or suddenly stops eating as well as she did?  Now, there are a number of different reasons why this change may be happening.  It could be due to a urinary tract infection, a change in medication, a problem with blood sugar, or any number of things.  But we shouldn’t dismiss the possibility that the person developed a subdural hematoma when she fell in the bathroom last week.

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