Received: 05.04.2022; Accepted: 12.05.2022; Published on-line 15.06.2022

Papilledema in chronic subdural hematoma: how often it is seen and what has changed?

Kadzhaia M. V. 1, Malysheva T. A. 1, Vasyuta V. A. 1, 

Gotin O. S. 1, Diadechko A. O. 1, Borovik L. R. 1, 2,

1 The SI "Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine"; Kyiv (Ukraine) 

2 Zaporizhzhia City Clinical Emergency Care Hospital; Zaporizhzhia (Ukraine)

TO CITE THIS ARTICLE:Kadzhaia MV, Malysheva TA,  Vasyuta VA,  Gotin OS, Diadechko AO, Borovik LR. Papilledema in chronic subdural hematoma: how often it is seen and what has changed?J.ophthalmol.(Ukraine).2022;3:58-62.    http://doi.org/10.31288/oftalmolzh202235862


Background: A chronic subdural hematoma (CSDH) is defined as an encapsulated accumulation of a clot of blood and degraded blood products on the surface of the brain between the dural and arachnoid membranes. Papilledema had for a long time been referred to as a characteristic objective symptom of CSDH. The incidence of papilledema is however, variable and depends on a variety of factors.

Purpose: To analyze the data on the diagnosis of papilledema in patients with CSDH and to review the place of papilledema among the clinical findings in CSDH.

Material and Methods: We retrospectively reviewed the medical records of 164 patients with CSDH who underwent treatment at the Romodanov Neurosurgery Institute and Zaporizhzhia City Clinical Emergency Care Hospital from 2011 through 2021. Patients underwent clinical-and-neurological, ophthalmological, and neuroimaging examinations.

Results: Papilledema was found in 4 (2.4%) of the patients. All these four patients had moderate papilledema which regressed after surgery. Details of these cases were reviewed.

Conclusion: A shift in the peak incidence of CSDH towards an older age group and an increasing use of neuroimaging modalities exert an impact on the incidence of papilledema in patients with CSDH. Papilledema was found in 2.4% of the patients of the study. 

Keywords: chronic subdural hematoma, diagnostic assessment, papilledema, optic nerve, headache, age



1.Feghali J, Yang W, Huang J. Updates in Chronic Subdural Hematoma: Epidemiology, Etiology, Pathogenesis, Treatment, and Outcome. World Neurosurg. 2020 Sep;141:339-345.

Crossref  PubMed

2.Bartek J Jr, Sjavik K, Stahl F, Kristiansson H, Solheim O, Gulati S, et al. Surgery for chronic subdural hematoma in nonagenarians: a Scandinavian population-based multicenter study. Acta Neurol Scand. 2017 Nov;136(5):516-20.

Crossref  PubMed

3.Ou Y, Dong J, Wu L, Xu L, Wang L, Liu B, et al. A comparative study of chronic subdural hematoma in three age ranges: Below 40 years, 41-79 years, and 80 years and older. Clin Neurol Neurosurg. 2019 Mar;178:63-69.

Crossref  PubMed

4.Balser D, Farooq S, Mehmood T, Reyes M, Samadani U. Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations. J Neurosurg. 2015 Nov; 123(4):1209–15.

Crossref  PubMed

5.Eliseeva NM, Serova NK. [Papilledema and its differential diagnosis: A guide for physicians]. Moscow: Triadа; 2018. Russian.

6.Scott СJ, Kardon RH, Lee AG, Frissen L. Diagnosis and grading of papilledema in patient with raised intracranial pressure using optical coherence tomography vs clinical experts assessment using a clinical staging scale. Arch Ophthalmol. 2010;128(6):705-11. 

Crossref  PubMed

7.Mohamed MT, Aldghamy AH, Elsoghair OA. Diagnosis and grading of papilledema using optical coherence tomography compared to clinical staging by Frise'n Scale. SVU-IJMS. 3(2):14-19 


8.Greenberg D, Aminoff M, Simon R, eds. Lange Clinical Neurology. 11th edition. New York, NY: McGraw-Hill Education; 2020.

9.Liu GT, Volpe NJ, Galetta SL, eds. Neuro-ophthalmology: Diagnosis and Management. 3rd edition. London: Elsevier Saunders; 2018.

10.Advances in Neurotraumatology. Vigouroux RP, Editor-in-Chief. Volume 1. Extracerebral Collections. McLaurin RL, Managing Editor.  Wien: Springer–Verlag; 1986.

11.Handbook of ophthalmologic emergencies: a guide for emergencies in ophthalmology. Gombos GM, edr. Flushing, NY: Medical Examination Pub.; 1973.

12.Zasler ND, Katz DI, Zafonte RD, eds. Brain injury medicine: principles and practice. 2nd ed. New York, NY: Demos Medical Publishing; 2012.


13.Mahapatra AK, Kamal R, Kumar R, eds. Textbook of Traumatic Brain Injury. New Delhi, India: Jaypee Brothers Medical Publishers; 2012.

Crossref  PubMed 

14.Kuddus R, Hossain MA, Hossain SKS, Hossain ATMM, Debnath H, Rahman A, et al. Study on clinical features and factors associated with thickness of chronic subdural hematoma in adult. Bangabandhu Sheikh Mujib Med Univ J. 2018; 11: 209-12.


15.Yamada SM, Teramoto A, Yamada S, Hoshiai YC. Severe papilledema identified 3 weeks after head injury. Neurol Med Chir (Tokyo). 2002 Jul;42(7):293-6.

Crossref  PubMed

16.Park SH, Kim YS, Chung SS, Lee KC. Clinical Analysis of Treatment of Chronic Subdural Hematoma. J Korean Neurosurg Soc. 1984 Dec; 13(4): 669-79.

17.Yamada SM, Tomita Y, Murakami H, Nakane M, Yamada S, Murakami M, et al. Headache in patients with chronic subdural hematoma: analysis in 1080 patients.  Neurosurg Rev. 2018 Apr;41(2):549-56.

Crossref  PubMed

18.Bartek J, Sjåvik K, Dhawan S, Sagberg LM, Kristiansson H, Ståhl F, et al. Clinical Course in Chronic Subdural Hematoma Patients Aged 18-49 Compared to Patients 50 Years and Above: A Multicenter Study and Meta-Analysis. Front Neurol. 2019 Apr 5;10:311. 

Crossref  PubMed

19.Wang HS, Kim SW, Kim SH. Spontaneous chronic subdural hematoma in an adolescent girl. J Korean Neurosurg Soc. 2013 Mar; 53(3):201–3.

Crossref  PubMed

20.Emamhadi M, Chabok SY, Alijani B, Behzadnia H, Rasoulian J, Andalib S. Spontaneous Chronic Subdural Hematoma: A Case Report and Literature Review. Trauma Mon. 2017 November; 22(6):e38529.


21.Dulani S, Dulani R, Lele S, Diagavane S, Anjankar S, Jaiswal N, et al. Chronic Subdural Haematoma in a Case of Hyperthyroidism Presenting with Papilledema. Chinese Medicine. 2012; 3 (4):179-81.


22.Won YD, Yi HJ, Lee YJ, Chun HJ, Cho H, Bak KH. Chronic Subdural Hematoma in Young Adult: An Age Comparison Study. Korean J Neurotrauma. 2013;9:6-11.


23.Kaste M, Waltimo O, Heiskanen O. Chronic bilateral subdural haematoma in adults. Acta Neurochir (Wien). 1979;48(3-4):231-6. 

Crossref  PubMed

24.Ou Y, Yu X, Liu X, Jing Q, Liu B, Liu W. A Comparative Study of Chronic Subdural Hematoma in Patients With and Without Head Trauma: A Retrospective Cross Sectional Study. Front Neurol. 2020 Nov 27;11:588242.

Crossref  PubMed

25.Iantosca MR, Simon RH. Chronic subdural hematoma in adult and elderly patients. Neurosurg Clin N Am. 2000 Jul;11(3):447-54. 



Corresponding Author: Vasyuta V.A., vasyuta.v@ukr.net

Author Contribution: Kadzhaia M.V.: concept; writing – design, reviewing and editing; formal analysis; Malysheva T.A.: concept; writing – design, reviewing and editing; formal analysis; Vasyuta V.A.: concept; writing – design, reviewing and editing; formal analysis; Gotin O.S.: writing – reviewing and editing;  Diadechko A.O.: writing – reviewing and editing;  Borovik L.R.: concept; writing - preparation of the initial project; writing - reviewing and editing. All authors analyzed the results and approved the final version of the manuscript.

Conflict of Interest: There is no conflict of interest.

Source(s) of Support:  There are no sources of support.

Abbreviations: CSDH, chronic subdural hematoma; MRI, magnetic resonance imaging; CT, computed tomography.