Brain, FroM Page 1:
Older age is leading factor
brain injury, Samadani said.
Heavy drinking causes liver damage that can disrupt the blood’s clotting functions, she explained. Likewise, the chance of developing a chronic SDH is significantly higher among those on anticoagulant medication, such as Coumadin (warfarin), commonly prescribed to prevent heart attacks, strokes and blood clots, especially for older adults.
As many as 24 percent of patients with the disorder were on warfarin or an anti-platelet drug to prevent clots, according to a study by researchers in Wales.
As many as 10 percent of patients had a history of alcoholism or epilepsy, the Welsh team reported. Obesity can be a contributing factor by increasing estrogen levels in the body, Samadani said.
However, older age remains the leading predisposing factor. As people age, the brain shrinks, creating a space into which fluid can collect. The veins that drain the brain must traverse this space, and even the slightest jolt can cause them to leak, leaving blood trapped against the brain. Also, these “bridging veins” become more fragile and susceptible to tears.
Chronic SDH has been described as “the great neurological imitator” because it often presents a confusing array of possible symptoms that can resemble, alternatively, a psychiatric disorder, dementia, a migraine, epilepsy, Parkinson’s disease, a stroke or a transient ischemic attack, also known as a ministroke.
Patients may develop a rather severe headache and weakness on one side of the body, have difficulty walking, seem confused or have trouble speaking, Samadani said. She added that chronic SDH “is a common treatable cause of dementia.”
Symptoms tend to develop rather suddenly, often without apparent explanation. Patients and their doctors need to be aware of the various symptoms and signs, and follow up with a CT scan that most often can reveal or rule out a subdural hematoma. The scan may need to be repeated using a dye if initial results are unclear.
TheWelshteamnotedthatthe most important factor in diagnosing chronic SDH was “a high index of suspicion” in patients whether or not they had a head injury or other trauma. Warning signs include headache; a change in mental status or worsening of pre-existing neurological or psychological illness; and neurological problems in a specific location like one side of the face, an arm or even a small area of the tongue.
Treatment of a chronic SDH is not always needed, though patients with a seemingly stable hematoma must be monitored, with prompt treatment if symptoms worsen.
If bleeding into the subdural space continues unchecked, it increases pressure on the brain that can lead to a loss of consciousness, permanent disability or death.
Onlyathirdofpatientsrequire surgical treatment, Samadani said. In the remaining twothirds, the hematoma is gradually reabsorbed without invasive treatment. Patients can also be given medication to help speed the process, she said.
While many chronic subdural hematomas cannot be prevented, the risk of developing one can be lowered by avoiding alcohol abuse, reducing the risk of falls and maintaining a normal body weight.
While there is no certain way yet to minimize brain shrinkage with age, Dr. Steven Flanagan, chairman of rehabilitative medicine at NYU Langone Medical Center, said, “Regular cardiovascular aerobic exercise is good not only for the heart and lungs, but also for cognitive function. Evidence suggests it increases brain-derived neurotrophic factor,” which promotes survival of the brain’s neurons.
Yet another reason to get — and stay — moving as you get older.