New imbalance, slowing, drowsiness or one-sided weakness weeks to months after an older person's head injury needs assessment and head CT
Chronic bleeding can develop around the third week after a head injury, even when the person initially seemed fine and cannot remember the impact. The cited consensus reports recurrence after surgery up to 33% and mortality up to 32%. If an older person suddenly becomes confused, unsteady, sleepy or weak in one hand, ask about falls or head impacts over the preceding two or three months and seek CT assessment.
What it takes
Around RMB 200–300 for head CT in the Chinese estimate.
What you may gain
A Chinese expert consensus on drug treatment of chronic subdural hematoma describes a slowly accumulating collection of blood between the arachnoid and dura that usually forms around the third week after head trauma, predominantly in older people. It reports postoperative recurrence up to 33%, mortality up to 32%, and favorable overall recovery in only 24% of patients over 90. A systematic review found worldwide annual incidence of 3.39–39.1 per 100,000, increasing with age and potentially threefold higher after 80. Trauma and falls were the commonest causes, followed by chronic heavy alcohol use, anticoagulants and violence. A geriatric review describes typical confusion, cognitive decline, gait disturbance or drowsiness that can resemble other geriatric syndromes.
Context & considerations
Symptoms may be absent at impact and the event forgotten. Ask retrospectively about recent head injuries rather than automatically labeling new confusion, imbalance, sleepiness or unilateral weakness as dementia or an old stroke's aftermath. Aspirin, clopidogrel, warfarin, newer oral anticoagulants and long-term heavy drinking increase risk. See fall prevention.
Research & references
Zhang J et al. (2021). Expert consensus on drug treatment of chronic subdural hematoma. Chinese Neurosurgical Journal, 7(1), 47. https://doi.org/10.1186/s41016-021-00263-z; Dziho A et al. (2025). Global prevalence and incidence of chronic subdural hematoma: A systematic review. Brain and Spine, 5, 105893. https://doi.org/10.1016/j.bas.2025.105893; Mathon B, Shotar E (2026). Diagnostic and therapeutic management of chronic subdural hematoma in elderly patients. Gériatrie et Psychologie Neuropsychiatrie du Vieillissement, 24(1), 30-41. https://doi.org/10.1684/pnv.2026.1274