Chronic Subdural Hematoma: Symptoms, Burr Hole Surgery and Recovery

What Is a Chronic Subdural Hematoma?

A chronic subdural hematoma is an old collection of blood and fluid between the brain's surface and its tough outer covering, the dura (MedlinePlus). It usually follows a minor head injury, especially in an older adult. Symptoms then build up over weeks, so families often blame age.

Meanwhile, the collection grows and presses on the brain. With timely treatment, however, most people recover well.

At a Glance

• Who it affectsMostly people over 65, often on blood thinners
• How it startsA minor bump, often forgotten, a few weeks earlier
• Typical signsHeadache, confusion, one-sided weakness or falls
• Key testA CT scan of the head, sometimes an MRI
• Main treatmentBurr hole drainage through small holes in the skull
• Flying homeUK guidance advises about 7 days after brain surgery

What Brought You Here?

First, pick the line closest to what you or your parent have noticed. Each one then opens the matching part of this guide.

1. 01A parent has become confused, drowsy or “not themselves”Changes that build up over days or weeks→
2. 02New weakness on one side, or slurred speechSigns that can look like a stroke→
3. 03A headache that keeps getting worse after a bumpEven a minor knock weeks ago counts→
4. 04Unsteady walking, new falls or bladder accidentsChanges that other conditions can mimic→
5. 05A scan shows a subdural hematoma: watch or operate?How doctors decide, and what surgery involves→
6. 06A recurrence, a second opinion or planned surgery abroadWhen travel to Istanbul makes sense, and when it does not→

Chronic Subdural Hematoma Symptoms

Symptoms depend on the size of the collection and where it presses (MedlinePlus). Most build up over days or weeks and also tend to come and go. So a person may seem fine in the morning, yet worse by evening.

Questions at this stage

When to See a Doctor, and When to Call an Ambulance

A chronic subdural hematoma can stay quiet for weeks and then worsen within hours. So act on the signs early.

Call 911 in the US and Canada, 999 in the UK or 112 in Europe. Also, such signs need the nearest hospital, not a flight abroad.

What Causes a Chronic Subdural Hematoma?

Most start when tiny bridging veins tear after a head injury, such as a fall (MedlinePlus). In older adults, even a minor knock can do it. Many people, in fact, never remember any injury.

Why It Shows Up Weeks Later

At first, only a little blood leaks, so nothing seems wrong. The body then wraps it in a thin membrane with fragile, oozing vessels. So, as Prof. Albayrak explains, symptoms often start three to six weeks later.

Who Has a Higher Risk?

With age, the brain shrinks slightly, so these veins stretch and tear more easily (MedlinePlus). For this reason, most patients are older adults, and men outnumber women.

• Long-term use of blood thinners, aspirin or other anti-inflammatory medicines (MedlinePlus)
• Long-term heavy alcohol use, or diseases that reduce blood clotting
• Frequent falls, kidney dialysis or epilepsy
• A shunt for hydrocephalus that drains too much fluid

In children, however, subdural bleeding has other causes; see pediatric neurosurgery. A head injury near an arachnoid cyst can also cause bleeding (NINDS).

Dementia, Stroke or a Subdural Hematoma?

A chronic subdural hematoma can mimic dementia or a stroke, so diagnosis often comes late. The speed of change gives the first clue. A CT scan then settles the question.

How Doctors Tell Them Apart

First, the doctor asks when each change began and how fast it grew. The conditions can also coexist, so dementia does not rule out a hematoma.

A shuffling walk with bladder accidents also suggests normal pressure hydrocephalus. Both can even appear together.

Slow personality change, however, can also come from a tumor; see brain tumour symptoms. In contrast, a sudden, severe headache suggests a burst brain aneurysm.

Acute vs Chronic Subdural Hematoma

Both types form in the same space, but they behave very differently. An acute one follows a serious injury and needs emergency care at the nearest trauma hospital.

How Doctors Diagnose a Chronic Subdural Hematoma

First, the doctor checks balance, strength, speech and thinking (MedlinePlus). If a hematoma seems likely, a CT or MRI scan then follows. Blood tests also check clotting, kidney and liver function.

A CT scan without contrast dye usually comes first. On it, Prof. Albayrak measures the collection's thickness and any shift of the brain's midline. An MRI then helps with two-sided hematomas, which may not shift the midline.

Does Every Chronic Subdural Hematoma Need Surgery?

No. Hematomas that cause no symptoms may not need treatment (MedlinePlus). Those with symptoms, however, usually do not heal on their own and often need surgery.

So during watchful waiting, Prof. Albayrak usually repeats the CT every four to six weeks. Any new symptom, however, changes the plan at once.

Chronic Subdural Hematoma Treatment Options

Once symptoms appear, surgeons usually drain the blood through small holes in the skull. Large hematomas or solid clots, however, may need a larger opening, a craniotomy (MedlinePlus).

Burr Hole Drainage, Step by Step

First, Prof. Albayrak chooses general anesthesia or, for frail patients, local anesthesia.

1. Through one or two small holes in the skull, the surgeon opens the dura.
2. The old, liquid blood drains out, and the surgeon rinses the space with saline.
3. A thin closed drain stays for 24 to 48 hours, because studies link drains to fewer recurrences.

Many patients then feel clearly better soon after surgery. Solid or walled hematomas, however, need a mini craniotomy, a slightly larger bone window.

Middle Meningeal Artery (MMA) Embolization

Here an interventional neuroradiologist blocks the small artery that feeds the hematoma's membrane. The aim is to lower the chance of a recurrence, sometimes alongside surgery.

In the UK, however, NICE (2023) advises using it only in research. NICE is now reviewing that advice.

Blood Thinners and a Subdural Hematoma

Blood thinners raise the risk of a subdural hematoma and of a recurrence. Stopping them, however, raises the risk of clots and stroke. So the plan always weighs both, together with your heart doctor.

First, before brain surgery, the team usually pauses blood thinners briefly (MedlinePlus). If necessary, it also corrects clotting with medicines or blood products.

Why a Chronic Subdural Hematoma Can Come Back

Chronic subdural hematomas often come back after drainage (MedlinePlus). In Prof. Albayrak's experience, most recurrences appear within the first three months. So follow-up scans matter even when you feel well.

Older age is the strongest factor, because a shrunken brain cannot fill the space quickly. Blood thinners, two-sided hematomas and walled collections also raise the risk.

Lowering the Risk

Prof. Albayrak uses a closed drain and also advises enough fluids after surgery. Falls matter too: more than one in four people aged 65 or older fall yearly (NIA). So good lighting and no loose rugs help (MedlinePlus).

If a hematoma returns, drainage then usually works again. For repeated recurrences, however, he may remove the membranes or discuss MMA embolization.

Recovery After Chronic Subdural Hematoma Surgery

Most patients feel clearer within the first day, and the headache usually fades quickly. The brain, however, needs weeks to return to its normal position.

A little fluid on the control scan is normal; the body absorbs it over weeks. Physiotherapy also helps older patients regain strength.

Driving After Surgery

In the UK, car drivers must stop driving and tell the DVLA (GOV.UK). They may then drive again once they recover.

Prof. Albayrak also usually advises about four weeks off driving, longer after a seizure. In the US and Canada, rules vary, so ask your doctor.

Coming to Istanbul from the US, Canada, the UK or Europe

A hematoma that is causing symptoms needs treatment where you are, not a long flight. Travel to Istanbul suits planned situations instead, with your own doctor's agreement.

When Travel Makes Sense

For example, some families seek a second opinion on a thin hematoma under watch. Others come for a recurrence, or for surgery on a mild, stable hematoma. Worsening confusion, new weakness or a seizure, in contrast, needs the nearest neurosurgical hospital.

Your Stay and the Flight Home

After surgery, Prof. Albayrak's patients usually spend three to five days in hospital. Gas left inside the skull can then expand at altitude (CAA).

So UK guidance advises about 7 days before flying. Flying after surgery also raises the risk of blood clots (CDC). Overall, plan for roughly two weeks in Istanbul, and keep the return date flexible.

Follow-Up at Home

Take home the discharge summary, the operation note and your scans (CDC). Also book a neurosurgeon near home for the four-to-six-week scan before you leave.

For US insurance and Medicare, see brain surgery in Turkey: planning from the US. For NHS rules, see planning from the UK. From Canada, check with your provincial health plan and private insurer before you book.

Your Subdural Hematoma Surgeon in Istanbul

Prof. Dr. Serdar Baki Albayrak

Neurosurgeon · Full Professor of Neurosurgery

Prof. Albayrak treats chronic subdural hematomas mainly with burr hole drainage and a closed drain. For walled or recurring collections, he uses a mini craniotomy. He also plans blood thinner pauses with your heart doctor.

His experience covers surgery for head injuries and bleeding inside the skull. He completed his neurosurgery training at Istanbul University in 2004.

Clinical fellowships then followed at the University of Helsinki and at Harvard Medical School, Brigham and Women's Hospital. Consultations take place in English or Turkish.

27+Years

5,000+Operations

64Countries

33Publications

Figures from Prof. Albayrak's professional profile, September 2026. See his full publication list.

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