Doctors Explain Fear of Chronic Subdural Hematoma, which “Silently Progresses in the Brain and Recurs at a Certain Rate,” Strikes Kanagawa Prefectural Governor

Spreads in the brain over weeks to months

Kanagawa Prefecture Governor Yuji Kuroiwa, 71, who was hospitalized for surgery for a chronic subdural hematoma, has left the hospital. He is recovering well and is expected to return to his official duties. Governor Kuroiwa updated his SNS, revealing that the cause of the injury was that he “slipped and fell in an outdoor bath and hit the back of his head hard” on New Year’s Eve last year.

A “chronic” subdural hematoma. The name of this disease may be unfamiliar to many people. The trouble with this disease is that the cause is not a serious accident or severe pain, but rather an “extension of daily life,” making it difficult to recognize.

A slight stumble, a fall on one’s buttocks, or a slight bump on the head a few months ago.

Such a minor incident may later lead to a life-threatening situation. Dr. Satoshi Ozaki, director of the Ebina Neurology Clinic, sounds this warning. (” ” denotes Dr. Ozaki).

Chronic subdural hematoma is a disease in which blood slowly accumulates on the surface of the brain (under the dura mater) and the hematoma (blood clot) grows over time.

Dr. Ozaki explains.

The characteristic of chronic subdural hematoma is that symptoms do not appear immediately. Even if the patient is fine immediately after the fall, symptoms such as lightheadedness, headache, and forgetfulness may appear several weeks or months later. In many cases, both the patient and those around him or her overlook the symptoms, saying, “Something seems wrong, but maybe I’m just tired,” or “Maybe it’s just old age.

What is troublesome is when the patient has no recollection of having hit his or her head. If it is a minor fall, the person often does not remember. Sometimes, especially the elderly, they may not recognize the fall itself as an incident.”

What symptoms should one suspect of a chronic subdural hematoma?

Chronic subdural hematoma is characterized by a “left-right” difference in symptoms because blood often accumulates on one side of the body. Only one leg may limp or stumble. Difficulty in using strength in only one hand, or numbness on one side of the body. The mouth of one side drops or is difficult to move. Although it closely resembles the characteristics of cerebral infarction, chronic subdural hematoma is a disease that often improves with treatment. That is why it is important to find it early.”

Recurrence at a certain rate

Dr. Ozaki listed the following three categories of people who are susceptible to chronic subdural hematoma.

Elderly people

As the brain atrophies with age, a gap tends to form between the brain and dura mater. As a result, blood vessels are more likely to break even with a slight shock.

People taking blood thinners (antithrombotic drugs)

If you are taking antiplatelet drugs (aspirin, etc.) or anticoagulants (warfarin, DOAC, etc.), it is difficult to stop bleeding.

Those who are habitual drinkers.

‘Not only does it increase the risk of falls, but it also affects liver function and coagulation capacity’

The diagnosis and treatment of chronic subdural hematoma is surprisingly simple.

A CT scan will show it quite clearly, and an MRI can also diagnose it, but a CT is enough to start with. If there is any doubt, it is important not to wait and see, but to have an examination immediately. If the hematoma is large and symptomatic, surgery is the first choice for treatment. Most often, this is a procedure called perforator drainage, in which a small hole is drilled into the skull to remove the accumulated blood. It is a surgery that takes only a short time and is relatively less invasive (less stressful and damaging to the body).

Unlike the “major surgery that involves craniotomy and touching the brain,” as most people imagine it, this surgery can be performed safely even on elderly patients. Chronic subdural hematoma is a disease that is expected to improve with treatment.

“Many people who undergo surgery experience improvement in their lightheadedness and paralysis,” he said. Some people say, ‘I suddenly feel better. However, we need to be careful about recurrence. Chronic subdural hematomas recur at a certain rate. In particular, those taking antithrombotic drugs and the elderly tend to be more prone to recurrence. However, even if it recurs, it can often be treated with reoperation if it is early. It is advisable to see a doctor as soon as you notice any abnormality.”

Chronic subdural hematoma is a slow-growing disease, and the cost of late detection is high.

As the hematoma grows, the brain can become compressed, resulting in impaired consciousness and even death. While it is a disease that has a high chance of being cured, it is also a dangerous disease if left untreated. If you experience unusual headaches, lightheadedness, difficulty walking, discomfort in one limb, or difficulty speaking, please see a doctor as soon as possible.”

Governor Kuroiwa’s report is not something that will happen to anyone else as they get older. It could happen to my family, and it could happen to me. Accepting this as such will be a step toward protecting our lives.