Chronic subdural haematoma

A chronic subdural haematoma is a slow collection of old blood between the surface of the brain and its outer covering. It often starts weeks after a head knock that seemed minor, or that was forgotten, but it can also happen spontaneously, and it is more common in older people and in people on blood thinners. The usual treatment is for a neurosurgeon to drain the blood through a small hole in the skull, although it can come back. Middle meningeal artery (MMA) embolisation blocks the artery that feeds the lining of the haematoma: a catheter is guided through an artery at the wrist or groin to the MMA, and tiny particles or liquid close it, with the aim of lowering the chance that the haematoma returns. It is an option for selected people, often those at higher risk of the haematoma returning or fragile patients not fit for surgery. It is not a replacement for surgery, and the decision is made with the neurosurgery team. Risks include bleeding or bruising where the catheter went in, stroke (rare), and the haematoma not shrinking. Signs to watch for, especially in an older relative: headache that is getting worse, confusion, memory or personality change, sleepiness, unsteady walking or falls, weakness on one side, and sometimes seizures. Get medical help promptly.