scholarly journals Expert consensus on drug treatment of chronic subdural hematoma

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Jianning Zhang ◽  
Zhou Fei ◽  
Hua Feng ◽  
Guodong Gao ◽  
Jiehe Hao ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Elderly Patients ◽  
Drug Treatment ◽  
Subdural Hematoma ◽  
Low Dose ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Postoperative Recurrence ◽  
Continuous Treatment ◽  
First Choice

AbstractChronic subdural hematoma (CSDH) is a chronic space-occupying lesion formed by blood accumulation between arachnoid and dura mater, which is usually formed in the third week after traumatic brain injury. Surgical treatment is usually the first choice for patients with CSDH having a significant space-occupying effect. Most of the patients showed good results of surgical treatment, but still some patients had a postoperative recurrence (the recurrence rate was up to 33%). Because CSDH is often seen in the elderly, patients are weak and have many basic diseases. The risk of surgical treatment is high; serious complications and even death (the death rate is up to 32%) can often occur. The overall good prognosis rate of patients aged more than 90 years is 24%. The drug treatment can provide a safe and effective treatment for elderly patients who are weak, intolerable to surgery, or failed in surgery. Low-dose and long-term use of atorvastatin (20mg/d) is suggested for continuous treatment for at least 8 weeks, while low-dose and short-term use of dexamethasone can improve the therapeutic effect of atorvastatin on CSDH. Patients should undergo CT or MRI scanning at least one time within 2 weeks after the start of drug treatment.

scholarly journals Profile of procedures for the treatment of chronic suddural hematoma in the state of São Paulo

2021 ◽  
Author(s):  
Paulo Roberto Hernandes Júnior ◽  
Bruno Carvalho Brandão ◽  
Juliana de Souza Rosa ◽  
Heloá Santos Faria da Silva ◽  
Patrick de Abreu Cunha Lopes ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Mortality Rate ◽  
Private Sector ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Sao Paulo ◽  
The State ◽  
São Paulo ◽  
Public Care

Background: Chronic subdural hematoma is a common type of intracranial hemorrhage with a greater predominance in the elderly. Objectives: To analyze the current panorama of surgical treatment procedures for chronic subdural hematoma performed in the State of São Paulo and to correlate the current epidemiology with the results obtained. Methods: A literature review and an observational, descriptive and transversal data collect on surgical treatment was carried out, available from January 2008 to December 2020 and articles available in Scielo, Lilacs and PubMed. Results: There were 15,148 hospitalizations for surgical procedures for the treatment of chronic subdural hematoma, representing a total expenditure of R$ 45,365,258.21, with 2018 being the year with the highest number of hospitalizations (1,418) and with the highest amount spent during the period (R$ 4,570,334.28). 678 of them were elective while 11,671 were urgent. 3,820 were carried out in public care and 4,317 in private one. All of them were considered medium complexity. Mortality rate was 9.20, corresponding to 1,393 deaths, with 2020 the year with the greatest mortality, 10.24, and 2013 with the lowest, 8.00. The mortality rate for elective procedures was 10.18 compared to 9.63 for urgent procedures, whereas in the public sector it was 8.09 compared to 9.73 for the private sector. The average total hospital stay was 8.7 days, with an average cost of R$ 2,994.80. Conclusion: There is a greater number of hospitalizations in the urgency and private sector and a higher mortality rate in elective procedures and in the private sector.

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.

Postoperative recurrence of chronic subdural hematoma is more frequent in patients with blood type A

2021 ◽  
pp. 1-5
Author(s):  
Satoshi Hirai ◽  
Kenji Yagi ◽  
Keijiro Hara ◽  
Eiichiro Kanda ◽  
Shunji Matsubara ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Type A ◽  
Postoperative Recurrence ◽  
Blood Type ◽  
Bleeding Tendency ◽  
Significant Independent Predictor ◽  
Study Results ◽  
Abo Blood Type

OBJECTIVEBecause of an aging society, the incidence of chronic subdural hematoma (CSDH) is increasing. This lesion is treated with simple burr hole irrigation, but one of the major issues is that CSDH frequently recurs. ABO blood type may be associated with a bleeding tendency and inflammation. However, its association with the recurrence of CSDH remains unknown. Therefore, the authors of the present study aimed to retrospectively investigate the association between ABO blood type and CSDH recurrence.METHODSThe authors retrospectively analyzed symptomatic CSDHs in 425 cerebral hemispheres of 376 patients who had undergone surgical treatment with irrigation of the hematoma via burr holes at their institution from January 2011 to September 2019. Among these were 366 CSDHs in 320 patients whose ABO blood type had been determined and who were included in this study.RESULTSIn the study, 307 patients with CSDHs in 350 hemispheres were followed up postoperatively until the disappearance of the CDSH or for at least 3 months. Recurrence of CSDH was observed in 37 patients (10.6%) after surgical treatment. Blood type A was found to be significantly associated with CSDH recurrence compared to non-A blood types: 24 of 153 CDSHs (15.7%) versus 13 of 197 CDSHs (6.6%) (p = 0.008). In the multivariable regression analysis, blood type A, in addition to thrombocytopenia, was a significant independent predictor of the recurrence of CSDH.CONCLUSIONSThe study results showed that blood type A is an independent risk factor for the postoperative recurrence of CSDH and that careful follow-up in these patients may be needed.

Chronic subdural hematoma: Surgical treatment and outcome in 104 patients

1997 ◽  
Vol 48 (3) ◽  
pp. 220-225 ◽  
Author(s):  
Ralf-Ingo Ernestus ◽  
Piotr Beldzinski ◽  
Heinrich Lanfermann ◽  
Norfrid Klug
Keyword(s):  
Surgical Treatment ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma

scholarly journals Intracerebral Hemorrhage Immediately Following Surgical Treatment of Chronic Subdural Hematoma

1984 ◽  
Vol 24 (1) ◽  
pp. 27-29 ◽  
Author(s):  
Noboru NAKAHARA ◽  
Toshio MASUZAWA ◽  
Koichi KUNO ◽  
Fumiaki SATO
Keyword(s):  
Surgical Treatment ◽  
Intracerebral Hemorrhage ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma

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

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.

Cerebrospinal fluid leakage into the subdural space: possible influence on the pathogenesis and recurrence frequency of chronic subdural hematoma and subdural hygroma

2008 ◽  
Vol 108 (2) ◽  
pp. 275-280 ◽  
Author(s):  
Rudolf A. Kristof ◽  
Jochen M. Grimm ◽  
Birgit Stoffel-Wagner
Keyword(s):  
Cerebrospinal Fluid ◽  
Recurrence Rate ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Postoperative Recurrence ◽  
Cerebrospinal Fluid Leakage ◽  
Subdural Space ◽  
Subdural Hygroma ◽  
Fluid Leakage ◽  
Csf Leakage

Object The purpose of this study was to clarify whether cerebrospinal fluid (CSF) leakage into the subdural space is involved in the genesis of chronic subdural hematoma (CSDH) and subdural hygroma (SH) and to clarify whether this leakage of CSF into the subdural space influences the postoperative recurrence rate of CSDH and SH. Methods In this prospective observational study, 75 cases involving patients treated surgically for CSDH (67 patients) or SH (8 patients) were evaluated with respect to clinical and radiological findings at presentation, the content of β -trace protein (β TP) in the subdural fluid (βTPSF) and serum (βTPSER), and the CSDH/SH recurrence rate. The βTPSF was considered to indicate an admixture of CSF to the subdural fluid if βTPSF/βTPSER > 2. Results The median β TPSF level for the whole patient group was 4.29 mg/L (range 0.33–51 mg/L). Cerebrospinal fluid leakage, as indicated by βTPSF/βTPSER > 2, was found to be present in 93% of the patients with CSDH and in 100% of the patients with SH (p = 0.724). In patients who later had to undergo repeated surgery for recurrence of CSDH/SH, the βTPSF concentrations (median 6.69 mg/L, range 0.59–51 mg/L) were significantly higher (p = 0.04) than in patients not requiring reoperation (median 4.12 mg/L, range 0.33–26.8 mg/L). Conclusions As indicated by the presence of βTP in the subdural fluid, CSF leakage into the subdural space is present in the vast majority of patients with CSDH and SH. This leakage could be involved in the pathogenesis of CSDH and SH. Patients who experience recurrences of CSDH and SH have significantly higher concentrations of βTPSF at initial presentation than patients not requiring reoperation for recurrence. These findings are presented in the literature for the first time and have to be confirmed and expanded upon by further studies.

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.

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