August 26, 2026
Chronic subdural hematoma is one of the more common neurosurgical conditions affecting older adults, yet it is also one of the most frequently missed or delayed diagnoses in this population, largely because its symptoms can develop so gradually and can so closely resemble other conditions common in aging, such as dementia, stroke, or simply the effects of aging itself. Understanding what a chronic subdural hematoma is, why older adults are particularly susceptible, and how it is diagnosed and treated can help families recognize the warning signs earlier and seek appropriate care sooner.
A subdural hematoma is a collection of blood that accumulates between the brain’s surface and its outermost protective covering, called the dura mater, and the term “chronic” specifically refers to a subdural hematoma that has developed slowly over a period of weeks, distinguishing it from an acute subdural hematoma that develops rapidly, usually as a result of a significant head injury. Chronic subdural hematomas typically form when small veins that bridge the space between the brain’s surface and the dura mater tear, often following a relatively minor head injury, and slowly leak blood into this space over an extended period.
Because the bleeding is slow, the brain often has time to partially accommodate the growing collection of blood, which is part of why symptoms in older adults can be so gradual and subtle compared to the often dramatic presentation of an acute subdural hematoma.
Several age-related factors make older adults particularly susceptible to developing chronic subdural hematomas, even after relatively minor head trauma that might not cause any injury in a younger person. As the brain naturally shrinks somewhat with age, a process called cerebral atrophy, additional space opens up between the brain’s surface and the skull, which increases tension on the bridging veins and makes them more vulnerable to tearing, even with minor jarring movements of the head.
Many older adults also take blood-thinning medications for conditions such as atrial fibrillation or a history of blood clots, and these medications, while important for their intended purposes, significantly increase the risk of bleeding and can turn what would otherwise be a trivial bump on the head into a slowly expanding chronic subdural hematoma. Additionally, older adults are statistically more prone to falls, providing more frequent opportunities for the kind of minor head trauma that can initiate this process, even when the fall itself seems unremarkable at the time.
The symptoms of chronic subdural hematoma are notoriously variable and can develop so gradually that neither patients nor their families immediately connect them to a head injury, which may have occurred weeks earlier and seemed minor at the time. Cognitive changes, including confusion, memory problems, and difficulty concentrating, are common and are frequently mistaken for early dementia or simply attributed to normal aging, which is one of the primary reasons this condition is so often diagnosed later than it should be.
Other common symptoms include persistent headaches, unsteady gait and balance problems that can increase fall risk, weakness on one side of the body, and noticeable changes in personality or level of alertness. Because these symptoms overlap so significantly with other common conditions affecting older adults, including stroke, dementia, and normal pressure hydrocephalus, a chronic subdural hematoma should always be considered as a possible explanation whenever an older adult experiences new or worsening cognitive or neurological symptoms, particularly if there has been any recent fall or head trauma, however minor it may have seemed.
Diagnosis of a chronic subdural hematoma is typically made through CT or MRI imaging of the brain, which clearly shows the characteristic crescent-shaped collection of blood along the brain’s surface, and imaging can also reveal how much the growing hematoma is compressing the underlying brain tissue. Because symptoms can be so nonspecific, brain imaging should be considered for any older adult presenting with new confusion, cognitive decline, weakness, or balance problems, especially in the context of any known or possible recent head trauma, even trauma that occurred weeks earlier and seemed insignificant.
A thorough history, including specific questions about recent falls or bumps to the head and current use of blood-thinning medications, is an important complement to imaging and can help raise clinical suspicion for this diagnosis even before imaging is obtained.
Treatment for chronic subdural hematoma depends primarily on the size of the hematoma, the severity of symptoms, and how much the hematoma is compressing surrounding brain tissue. For small, minimally symptomatic chronic subdural hematomas, careful observation with follow-up imaging may be appropriate, since some smaller hematomas can gradually resolve on their own without intervention, particularly if any contributing blood-thinning medications can be safely adjusted. For larger or more symptomatic hematomas, surgical drainage is generally recommended, and this is often accomplished through a relatively straightforward procedure called burr hole drainage, in which one or more small openings are made in the skull to allow the accumulated blood to be drained, relieving pressure on the brain.
Burr hole drainage is generally well tolerated even in frail, elderly patients and often produces significant, sometimes dramatic improvement in symptoms within days of the procedure. In some cases, particularly with hematomas that have a more solid or organized consistency, a larger surgical opening called a craniotomy may be necessary to more completely remove the hematoma.
Many older adults recover remarkably well following treatment for chronic subdural hematoma, particularly when the condition is diagnosed and treated promptly before symptoms become severe or prolonged, underscoring why timely recognition of this condition matters so much. Recurrence is a recognized possibility after treatment, particularly in patients who continue to require blood-thinning medications or who experience additional falls, so follow-up imaging and ongoing monitoring are typically recommended after treatment. Because chronic subdural hematoma can so easily be mistaken for other conditions common in aging, families and caregivers who notice new confusion, personality changes, balance problems, or other neurological symptoms in an older loved one, particularly following any recent fall or head bump, should raise the possibility of this diagnosis with their physician and specifically ask whether brain imaging is warranted.
Recognizing chronic subdural hematoma early, rather than attributing symptoms to inevitable aging or unrelated conditions, can make a meaningful difference in how quickly a patient receives appropriate treatment and how completely they recover.
A chronic subdural hematoma is very treatable once it’s identified, and early evaluation makes a real difference in recovery. Call (866) 467-1770 to discuss symptoms in a loved one, or Request a Consultation Online to schedule an evaluation.