Recurrent Chronic Subdural Hematoma: Clinical and Imaging Risk Factors

2018 ◽  
Vol 15 (01) ◽  
pp. 008-015 ◽  
Author(s):  
Benaissa Abdennebi ◽  
Maher Al Shamiri
Keyword(s):  
Risk Factors ◽  
Subdural Hematoma ◽  
Heart Diseases ◽  
Chronic Subdural Hematoma ◽  
Antiplatelet Agents ◽  
The Elderly ◽  
Imaging Data ◽  
Anticoagulation Agents ◽  
The Right ◽  
Recurrence Group

Abstract Background Chronic subdural hematoma (CSDH) is a major cause of neurosurgical emergencies in the elderly. Despite the use of routine surgical practices, recurrence of this condition is expected. This study was conducted to identify the risk factors (RF) for recurrent CSDH. Methods Between January 2016 and July 2017, 103 consecutive patients suffering from CSDH were admitted to our department. The no-recurrence group (NRG) consisted of 91 patients, and the recurrence group (RG) consisted of 12 patients. To identify the RF involved in recurrent CSDH, we analyzed multiple factors, including patient comorbidities and imaging data. Results Between the two groups, there were no statistical differences (p > 0.05) for head trauma, diabetes mellitus (DM), high blood pressure, heart diseases, anticoagulation agents, or seizures; however, DM was associated with one of the above-mentioned factors. In contrast, there were significant differences for antiplatelet agents (APA) (p < 10–6) and the right side of the hematoma location (p = 0.03). Conclusion Although the literature highlights the controversy regarding RF for CSDH, we detected APA and the right side as RF, whereas DM alone or associated with another comorbidity does not affect the CSDH outcome.

scholarly journals Chronic subdural hematoma: epidemiological and prognostic analysis of 176 cases

2015 ◽  
Vol 42 (5) ◽  
pp. 283-287 ◽  
Author(s):  
JAMIL FARHAT NETO ◽  
João Luiz Vitorino Araujo ◽  
Vinícius Ricieri Ferraz ◽  
Luciano Haddad ◽  
José Carlos Esteves Veiga
Keyword(s):  
Subdural Hematoma ◽  
Drainage System ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Prognostic Indicators ◽  
Altered Consciousness ◽  
Prognostic Analysis ◽  
Motor Abnormalities ◽  
The Right ◽  
Change Of Consciousness

Objective : To characterize patients with chronic subdural hematoma undergoing surgery and to identify prognostic indicators. Methods : We conducted a retrospective analysis of patients diagnosed with chronic subdural hematoma (CSDH) undergoing surgical treatment. We analyzed: age, period from trauma to diagnostic imaging, pre and postoperative Glasgow coma scale, type of surgery, associated comorbidities, use of postoperative drainage and outpatient treatment. Results : The sample consisted of 176 patients, 126 male and 50 female patients (ratio 2.5 : 1), ages ranged from six months to 97 years, with an average of 59.3 years. CSDH was caused by trauma in 52% of patients, with the time from trauma to imaging averaging 25.05 days; 37.7% were hypertensive patients and 20% had a neurological disease. Eighty-five (48.3%) patients were elderly and altered consciousness was present in 63% of cases. Of the 91 (51.7%) non-elderly patients, 44% presented with headache, altered consciousness occurred in 40% and motor abnormalities in 27.5%. The CSDH was located on the right in 41%, left in 43% and bilaterally in 16% of patients. Conclusion : the change of consciousness was the most common clinical alteration in the elderly and headache in non-elderly. The most associated comorbidity was the arterial hypertension and the most frequent cause, head trauma. The trepanation with two oriffices associated with a closed drainage system was the most used operating, with high efficacy and low complication rate.

Frequency of and Risk Factors for Chronification in Traumatic Acute Subdural Hematoma following Conservative Therapy

2019 ◽  
Vol 80 (05) ◽  
pp. 359-364 ◽  
Author(s):  
Stefanie Kaestner ◽  
Marina van den Boom ◽  
Wolfgang Deinsberger
Keyword(s):  
Risk Factors ◽  
Subdural Hematoma ◽  
Head Injuries ◽  
Chronic Subdural Hematoma ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Coagulation System ◽  
Acute Subdural Hematoma ◽  
Neurosurgical Department ◽  
Anticoagulant Medication

Background In an aging society, traumatic head injuries, such as acute subdural hematomas (aSDHs), are increasingly common because the elderly are prone to falls and are often undergoing anticoagulation treatment. Especially in advanced age, cranial surgery such as craniotomies may put patients in further jeopardy. But if treatment is conservative, a chronic subdural hematoma (cSDH) may develop, requiring surgical evacuation. Existing studies have reported a correlation between several risk factors contributing to the frequency of chronification. To improve the prediction of the course of disease and to aid counseling patients and relatives, this study aimed to determine the frequency and the main risk factors influencing the process of chronification of an aSDH following conservative treatment. Methods We identified patients presenting between January 2012 and September 2017 at our neurosurgical department with an aSDH. All patients treated conservatively were selected retrospectively, and the following parameters were documented: age, sex, chronification status, Glasgow Coma Scale score on admission and discharge, hematoma thickness and density, the degree of midline shift (MLS), prior anticoagulants and administration of procoagulants, thrombosis management, other coagulopathies, initial length of hospital stay, interval between discharge and readmission, and interval between initial injury and date of surgery and last follow-up. The cohort was divided into patients with complete resolution of their aSDH, and patients who needed surgery due to chronification. Results A total of 75 conservatively treated patients with aSDH were included. A chronification was observed in 24 cases (32%). The process of chronification takes an average of 18 days (range: 10–98 days). The following factors were significantly associated with the process of chronification: age (p = 0.001), anticoagulant medication (acetylsalicylic acid [ASA], Coumadin, and novel anticoagulants [NOACs]) before injury (p = 0.026), administration of procoagulants (p = 0.001), presence of other coagulopathies such as thrombocytopenia (p = 0.002), low hematoma density at discharge (p = 0.001), hematoma thickness on admission and discharge (p = 0.001), and the degree of MLS (p = 0.044). Conclusion Chronification occurred in a third of all patients with conservatively treated aSDH, on average within 3 weeks. The probability of developing a cSDH is 0.96 times higher with every yearly increase in age, resulting in 56% chronification in patients ≥ 70 years. Hematoma thickness and impairment of the coagulation system such as anticoagulant medication (ASA, Coumadin, and NOACs) or thrombocytopenia are further risk factors for chronification.

scholarly journals Warning with chronic subdural hematomas in the elderly

2021 ◽  
Vol 11 (4) ◽  
pp. 114-117
Author(s):  
Dinh Thi Phuong Hoai ◽  
Nguyen Thi My Dung ◽  
Hoang Manh Cuong ◽  
Huynh Thi Kieu Oanh ◽  
Ngo Thuy Tram ◽  
...  
Keyword(s):  
Left Hemisphere ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Mass Effect ◽  
The Elderly ◽  
Brain Parenchyma ◽  
History Of ◽  
Apparent Reason ◽  
The Right ◽  
Contrast Ct

Chronic subdural hematoma (cSDH) is a disorder in which blood collects between the dura and arachnoid mater of meninges around the brain. It's more common among the elderly and usually triggered by a head injury. We report a case of a 78-year-old male patient who had previously been diagnosed with a left hemisphere subdural hematoma for no apparent reason with a history of hypertension. Two days before hospitalizing, he had a symptom of weakness in the right extremities. Non-contrast CT of head reveals a crescent-shaped, heterodense lesion over the lateral aspect of the left hemisphere measuring 11x5x1 cm with mass effect to the adjacent brain parenchyma. Burr hole drainage was performed for the patient. His symptoms improved after the surgery.

Factors Favoring the Development of Chronic Subdural Hematoma After Traumatic Acute Subdural Hematoma in the Elderly

2021 ◽  
pp. 000313482110562
Author(s):  
Tarik Wasfie ◽  
Nicholas Fitzpatrick ◽  
Mursal Niasan ◽  
Jennifer L. Hille ◽  
Raquel Yapchai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Anticoagulant Therapy ◽  
Subdural Hematoma ◽  
Significant Risk ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Acute Subdural Hematoma ◽  
Mortality Data ◽  
Group A

Introduction Traumatic acute subdural hematoma (TASDH) is by far the most common traumatic brain injury in elderly patients presented to the emergency department, and a number of those treated conservatively will develop chronic subdural hematoma (CSDH). The factors contributing to chronicity were not well studied in the elderly; therefore, we retrospectively analyzed our elderly patients with acute subdural hematomas to identify the risk factors which might contribute to the development of subsequent CSDH. Methods A retrospective analysis of 254 patients with TASDH admitted between 2012 and 2016 to our level 2 trauma department in a community hospital was collected. Data include age, sex, comorbid conditions, CT findings, anticoagulant therapy, surgical interventions, disposition after discharge, and mortality. Data on those readmitted within the first 2 months with the diagnosis of CSDH were also studied (group A), and compared to those not readmitted (group B). Multiple logistic regression was used to determine the risk factors associated with readmission at P ≤ .05. Institutional review board approval was obtained for this study. Results There were 254 patients who were admitted with TASDH, 144 male (56.7%) and 110 female (43.3%), with the mean age of 71.4 (SD ± 19.38) years. Only 37 patients (14.6%) went for surgery in their initial admission. A total of 14 patients (5.6%) were readmitted subsequently with the diagnosis of CSDH within two months of initial discharge (group A). Only four patients (28.5%) were on anticoagulant therapy and these patients went for emergency craniotomy for evacuation of hematoma. All 14 patients had a history of coronary artery disease and hypertension and only 5 (35.7%) were diabetic. Review of head CT on initial admission of those patients revealed 4 patients (28.5%) had multiple lesions and 4 (28.5%) had tentorial/falax bleeding and 4 (28.5%) had a shift. The initial size and thickness of the bleeding was 1.4-5 mm. The adjusted model identified diabetes, race, and initial disposition as significant risk factors ( P < .05). Conclusion Risk associated with the transformation of TASDH to CSDH is difficult to assess in those group of elderly patients because of the small number; however, diabetes, race, and initial disposition to home pointed toward a risk for future development of CSDH and those patients should be followed clinically and radiographically over the next few months after discharge, particularly those on anticoagulant therapy.

scholarly journals Risk Factors for Chronic Subdural Hematoma after a Minor Head Injury in the Elderly: A Population-Based Study

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Jen-Ho Tseng ◽  
Ming-Yuan Tseng ◽  
Ann-Jeng Liu ◽  
Wen-Hsiung Lin ◽  
Hsiao-Yun Hu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Head Injury ◽  
Predictive Factors ◽  
Subdural Hematoma ◽  
Early Recognition ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Population Based ◽  
Population Based Study ◽  
Early Management

Chronic subdural hematoma (CSDH) is one of the major comorbidities in elderly resulting in disability and death. Early recognition of CSDH is important for early management. However, manifestations of CSDH are nonspecific and subtle. Therefore, identification of risk factors of CSDH can offer clinical follow-up strategies for patients after episodes of head injury. The purpose of the study aimed at identifying risk factors of CSDH of Taiwanese. Analysis of data from the National Health Insurance provides important information on predictive factors influencing the early diagnosis of CSDH in elderly patients following minor head injuries. The current study is the first nationwide population-based study in Taiwan, showing that old age (≥75 years), male gender, and coexisting hydrocephalus are significantly predictive factors, irrespective to their medical comorbidities.

Comparison of two drainage systems on chronic subdural hematoma (CSDH) recurrence

2021 ◽  
Author(s):  
Radwan Takroni ◽  
Nirmeen Zagzoog ◽  
Nimita Patel ◽  
Amanda Martyniuk ◽  
Forough Farrokhyar ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Subdural Hematoma ◽  
External Ventricular Drain ◽  
Drainage System ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
High Rate ◽  
Common Disease ◽  
Drainage Systems ◽  
Anticoagulation Agents

Background/Objectives Chronic Subdural Hematoma (CSDH) is a common type of intracranial hemorrhage, especially among the elderly, with a recurrence rate as high as 33%. Little is known about the best type of drainage system and its relationship with recurrence. In this study, we compare the use of two drainage systems on the recurrence rate of CSDH. Materials and Methods We retrospectively analyzed the charts of 180 CSDH patients treated with bedside twist drill craniostomy (TDC) and subdural drain insertion. Patients were divided into two groups: Group A (n=123) received our traditional drain (pediatric size nasogastric tube (NGT), while group B (n=49) had the external ventricular drain (EVD). Various demographic and radiological data were collected. Our main outcome was recurrence, defined as symptomatic re-accumulation of hematoma on the previously operated side within 3 months. Results 212 cases of subdural hematoma were treated in 172 patients. Majority of patients were male (78%) and had a history of previous head trauma (73%). 17 cases had recurrence, 11 in the NGT group drain and 6 in the EVD group. The use of antiplatelet or anticoagulation agents was associated with recurrence (P= 0.038 and 0.05, respectively). There was no difference between both groups in terms of recurrence [OR=1.42, 95% CI:0.49 to 4.08, P=0.573]. Conclusion Chronic subdural hematoma is a common disease with a high rate of recurrence. Although using a drain postoperatively has shown to improve the incidence of recurrence, little remains known about the best type of drain to use. Our analysis showed no difference in the recurrent rate between using the pediatric size NGT and the EVD catheter post TDC.

Long-term Functional and Neuropsychological Outcome Following Successful Treatment of Chronic Subdural Hematoma in the Elderly

Neurosurgery ◽  
1999 ◽  
Vol 45 (3) ◽  
pp. 731-731
Author(s):  
Vikram C. Prabhu ◽  
Vincent J. Miele ◽  
Deborah Rettig ◽  
Salli Lewis ◽  
Staci Robyn ◽  
...  
Keyword(s):  
Successful Treatment ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Neuropsychological Outcome

The risk factors for recurrence of chronic subdural hematoma

2012 ◽  
Vol 36 (1) ◽  
pp. 145-150 ◽  
Author(s):  
Shigeo Ohba ◽  
Yu Kinoshita ◽  
Toru Nakagawa ◽  
Hideki Murakami
Keyword(s):  
Risk Factors ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Risk Factors For Recurrence

scholarly journals Spontaneous resolution of large non-traumatic bilateral acute-on-chronic subdural hematoma

2017 ◽  
Vol 31 (1) ◽  
pp. 8-16
Author(s):  
D. Adam ◽  
D. Iftimie ◽  
Gina Burduşa ◽  
Cristiana Moisescu
Keyword(s):  
Conservative Treatment ◽  
Subdural Hematoma ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Neurological Status ◽  
Spontaneous Resolution ◽  
Subdural Hematomas ◽  
Gcs Score

Abstract Background and importance: Chronic subdural hematomas are a frequently encountered neurosurgical pathology, especially in the elderly. They often require surgical evacuation, but recent studies have shown good results with conservative treatment in selected cases. Clinical presentation: We report the case of a 72-year old patient that developed large, non-traumatic, bilateral, acute-on-chronic subdural hematoma after repeated abdominal surgery for appendicular carcinoma. He presented an abdominal wound infection and good neurological status (GCS score of 14 points), factors that indicated the delay of surgical intervention. Subsequent clinical and radiological improvement forestalled the operation altogether and he presented complete spontaneous resolution of subdural hematomas at only 5 months after diagnosis. Conclusion: Although surgical treatment is performed in the majority of chronic subdural hematomas, in clinically and radiologically selected cases, the operation can be avoided. The hematoma can present resolution, either spontaneously or with the help of conservative treatment.

scholarly journals Chronic subdural hematomas: challenges and solutions. Part I. Clinical variants and diagnosis

2021 ◽  
Vol 2 (2) ◽  
pp. 21-27
Author(s):  
Leonid B. Likhterman ◽  
◽  
Aleksandr D. Kravchuk ◽  
Vladimir A. Okhlopkov ◽  
◽  
...  
Keyword(s):  
Brain Imaging ◽  
Intracranial Hemorrhage ◽  
Subdural Hematoma ◽  
Clinical Course ◽  
Chronic Subdural Hematoma ◽  
Imaging Data ◽  
Clinical Variants ◽  
Brain Compression ◽  
Brain Imaging Data ◽  
Ct And Mri

Chronic subdural hematoma (cSDH) is a multifactorial extensive intracranial hemorrhage, causing the local and/or general brain compression. Hematoma has a delimiting capsule, which defines all pathophysiological features, clinical course and treatment tactics. The paper reports contemporary views on ethiology and clinical course of cSDH. Emphasis is placed on the diagnosis. Based on the analysis of 558 verified cSDH observations, the phasal course and brain imaging data are reported. CT and MRI signs of cSDH are defined.

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