On the evening of August 03, 2017 at about 8:00 PM I came through the front door of my condo with several bags of groceries. Without any warning my right leg suddenly lost all strength and I found myself sprawled on the floor surrounded by dropped groceries. I fell next to a sofa and was able to pull myself up from the floor. My right leg began to jerk from side to side and would not support my weight. The jerking subsided but the leg was weak; I managed to take three to four steps before falling again. I had my cell phone in my pocket so I called 911 and was transported to a local hospital’s ER. A CAT scan was done and it was determined that I had blood on the surface of my brain. I was admitted to the ICU and the following day another CAT scan was performed and the presence of blood was confirmed. By that time my leg seemed to have recovered and I was able to walk so I was moved from ICU to regular care; on Saturday I was given an MRI and the presence of blood on the brain was again confirmed. Late Sunday afternoon I was discharged and returned home with instructions to follow up with my personal physician and with the attending neurologist. I was also given an extensive list of things to do; things not to do and a list of symptoms to beware of. Surgery is not recommended at this time.
If anyone here has experienced a subdural hematoma or has a family member or friend who has I would greatly appreciate any inputs into what I can expect in the future by way of complications in life due to this new thing in my head.
Thanks in advance.
A small subdural hematoma will likely resolve on its own and leave no residual effects. Were there any thoughts about why it happened (the underlying cause)? SDHs don’t really happen all on their own; knowing what caused it, and what didn’t, could be a more important consideration then the SDH itself.
In general: A small subdural hematoma (SDH) should resolve on its own, as noted upthread. There should be some followup to make sure things are moving in the right direction. Possible complicating factors would be if someone takes blood thinners, in which case it should be watched more closely than otherwise.
A presentation with temporary loss of leg function and leg jerking sounds like a seizure. Many doctors would place patients presenting with a seizure on some kind of seizure prophylaxix, including medications and driving restrictions.
SDH is generally caused by trauma. This may be rather mild, incidental trauma in elderly patients or those on blood thinners. In a case like the OP described, the SDH may have been present previously and precipitated a seizure. Or a seizure may cause a fall and head trauma, leading to a secondary SDH. Imaging may permit estimation of the age of the SDH, helping sort out “chicken-egg” questions.
Here is a link to Mayo Clinic’s page, designed for patients:
Here is a link to Wikipedia article, also nice and has pics:
That’s what I had thought too but apparently in the relatively older (in particular those with a history of heavy drinking, on platelet inhibitors or anticoagulants, or obese) chronic SDH do often just happen all on their own without identified trauma, and often with a sudden presentation like this.
Thanks for the replies and the links. A few years back I had a series of falls during one of which I smacked my head very hard on a cement floor. That’s the only fall I can remember that might have resulted in an injury. A diagnosis of “Situational Vertigo” was made at that time but a CAT scan wasn’t performed and since I felt better immediately afterward I didn’t worry about it—I wish now that I had insisted on a scan. I have an appointment tomorrow with my regular doctor to follow up on my hospitalization and another appointment in two weeks with a neurologist—. For the time being I’m using a walker with a second walker in my shower stall.
The joys of getting older I suppose.
I guess it depends where you put your time zero. In order for something to be chronic it has to be acute first. So I think it’s a little misleading to say chronic SDH “just happens”. A chronic SDH happens because at some earlier time - what I would consider the true time zero -an acute SDH happened. So then the question is can an acute SDH “just happen”. Per my learnin’ the answer is probably not, or at least not very often. There has to be some inciting event, and the linked article even says that, or nearly does, as it references trauma seemingly so mild it was forgotten, or trauma that did not directly involve the head, but jostled the brain nonetheless.
As people age and the brain shrinks, +/- helped along by booze and/or other, it basically increases the “empty” space and thus range of motion for the brain to jiggle in, and so increases the risk that a jiggle will cause a bleed. Once a bleed happens, it may stop and restart, and repeat, hence, the acute becomes chronic. The rebleed may happen with even less of a jolt than the original, maybe even incidentally with more or less normal daily activities. The original bleed may have been self limiting to the extent that no significant symptoms developed. Then the rebleed, which could be bigger than the first one, could cause symptoms, which then might seem to have come"out of nowhere".
Getting back to the OP, that in fact may be what is happening. Those whacks back a while ago may have caused the acute bleed, then that stopped and was dormant, then rebled.
As someone already mentioned, I’m wondering why your leg lost strength. That seems to be just as troubling as the hematoma. My father nearly died of SDH that was caused by a bad fall he sustained in a drunken stupor (he was an alcoholic). Had surgery and managed to survive another 20+ years most of which were sober, but he started having odd symptoms that were hard to diagnose in later years and ultimately had a hemorrhagic stroke, which ultimately finished him off. I’d probably ask the doctor about the possibility of aneurysms.
Or the fairly distant history of whacks could be (and given that length of time likely are) a red herring.
The point of the article is that in many cases there is no identifiable trauma even in the cases there is “trauma” recalled it often seems very minor. (Possibly not even an actual inciting event.)
No cause other than age, especially if there are other fairly common historical risk factors, and usual living with normal jostling about, with sudden very significant symptoms, is apparently a very common presentation and it happens much more commonly than I would have guessed. Reading up on it because of the op reduced my ignorance significantly.
Reading more that seems the process of CSDH formation is currently believed to more than the bridging vein bit the NYT article discusses alone and not simple rebleeding, even microrebleeding alone either, but “angiogenesis, fibrinolysis and inflammation”. But sure, there had to be some time zero that started the process.
asahi, the presumption is that at some point the hematoma becomes large enough to exert pressure on the cortex which causes the acute symptoms including in some cases triggering acute seizures.
In addition to Aruvqan’s point, in Britain older people can register with an organization which co-ordinates medical alert devices people carry in various ways ( wrists, necklets etc. ) which when buzzed by someone who has fallen over etc. calls for help. Maybe they have something similar over there ?
I shall definitely get one sometime since I live alone.
I’m sort of hanging on at the moment while trying to get used to the idea.
I’ve had a follow up with my personal doctor; he has arranged for a home health aid service to provide three visits from a physical therapist to work with me to strengthen the leg.
I have made an appointment with the neurologist but haven’t seen him yet.