INDEPENDENT PREDICTORS FOR RECURRENCE OF CHRONIC SUBDURAL HEMATOMA

Neurosurgery ◽  
2008 ◽  
Vol 63 (6) ◽  
pp. 1125-1129 ◽  
Author(s):  
Kouichi Torihashi ◽  
Nobutake Sadamasa ◽  
Kazumichi Yoshida ◽  
Osamu Narumi ◽  
Masaki Chin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Anticoagulant Therapy ◽  
Subdural Hematoma ◽  
Independent Risk Factor ◽  
Multivariate Analyses ◽  
Independent Predictor ◽  
Chronic Subdural Hematoma ◽  
Time Interval ◽  
Anticoagulant Drugs

Abstract OBJECTIVE Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage with a substantial recurrence rate. We focused on determining independent predictors associated with the recurrence of CSDH. METHODS We retrospectively reviewed 343 consecutive surgical cases of CSDH. Univariate and multivariate analyses were performed to describe the relationships between recurrence of CSDH and factors such as sex, age, hypertension, diabetes mellitus, heart disease, cerebrovascular disease, atrial fibrillation, antiplatelet or anticoagulant therapy, and bilateral CSDH. RESULTS Sixty-one patients experienced a recurrence of CSDH. Univariate and multivariate analyses found that bilateral CSDH was an independent risk factor for the recurrence of CSDH. Although antiplatelet and anticoagulant therapy had no significant effect on recurrence of CSDH, the time interval between the injury and the first operation for patients with antiplatelet and/or anticoagulant therapy was shorter than that for patients without it (29.9 versus 44.2 days). CONCLUSION Bilateral CSDH was an independent predictor for the recurrence of CSDH. Antiplatelet or anticoagulant drugs might facilitate the growth of CSDH. These results may help to identify patients at high risk for the recurrence of CSDH.

Independent predictors of recurrence of chronic subdural hematoma: results of multivariate analysis performed using a logistic regression model

2003 ◽  
Vol 98 (6) ◽  
pp. 1217-1221 ◽  
Author(s):  
Hiromichi Yamamoto ◽  
Yutaka Hirashima ◽  
Hideo Hamada ◽  
Nakamasa Hayashi ◽  
Hideki Origasa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Multivariate Analysis ◽  
Subdural Hematoma ◽  
Logistic Regression Model ◽  
Multivariate Analyses ◽  
Chronic Subdural Hematoma ◽  
Ct Scans ◽  
Content Type ◽  
History Of ◽  
Fine Print

Object. The authors attempted to determine independent predictors that contribute to the recurrence of chronic subdural hematoma (CSDH). Methods. A total of 105 consecutive patients who underwent surgery for CSDH were included in this study. Eleven patients underwent a repeated operation because the CSDH recurred. Univariate and multivariate analyses were performed to assess the relationships among various variables and CSDH recurrence. Finally, four variables were found to be independently associated with the recurrence of CSDH: 1) absence of a multiplicity of hematoma cavities on CT scans; 2) presence of a history of seizure; 3) width of the hematoma; and 4) absence of a history of diabetes mellitus (DM). Conclusions. As previously reported, the width of the hematoma is related to the incidence of CSDH recurrence. In this study, the lack of a multiplicity of hematoma cavities was the favorite predictor of CSDH recurrence. In addition, histories of seizure and no past DM are closely related to the incidence of CSDH recurrence.

scholarly journals The Effect of Diabetes Mellitus on the Recurrence of Atrial Fibrillation after Ablation

2021 ◽  
Vol 10 (21) ◽  
pp. 4863
Author(s):  
Denise Guckel ◽  
Khuraman Isgandarova ◽  
Leonard Bergau ◽  
Misagh Piran ◽  
Mustapha El Hamriti ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Confidence Interval ◽  
Multivariate Analyses ◽  
Independent Predictor ◽  
Single Shot ◽  
Atrial Tachyarrhythmia ◽  
Kaplan Meier ◽  
Af Recurrence

Diabetes mellitus (DM) plays a crucial role in the regulation of atrial fibrillation (AF). This study aimed to evaluate the outcome of pulmonary vein isolation (PVI) using a single-shot device in patients with AF and DM. A total of 531 consecutive patients undergoing initial cryoballoon (CB)-guided PVI were evaluated. Two hundred eighty-one patients (53%) suffered from paroxysmal AF (PAF; mean age 51 ± 23.2 years, 26% female), 250 patients (48%) from persistent AF (PERS; 64 ± 10.0 years old, 30% female) and 80 patients (15%) were diagnosed with coincidental DM (68 ± 19.6 years old, 30% female). Follow-up visits were performed at 3, 6 and 12 months including 7-day Holter ECGs. Primary endpoint was the first documented recurrence of atrial tachyarrhythmia. AF recurrence occurred in 26% (140 patients). PAF patients with DM presented with a significantly higher risk for arrhythmia recurrence (Kaplan Meier analysis; Log rank p < 0.001 *). Multivariate analyses found DM to be an independent predictor (IP) for AF recurrence (p = 0.009 *, hazard ratio (HR) 4.363, confidence interval (CI) 1.456–13.074). In PERS, DM was associated with a 43% increase in AF recurrence (p = 0.320, HR 1.427, CI 0.707–2.879). DM has relevant effects on AF recurrence after PVI-only ablation approaches for AF. Major differences were observed in PAF as DM seems to favor the development of individual arrhythmia substrate, which is usually not yet present in PAF. In PERS, DM effects are less pronounced as individual fibrosis has already developed. Thus, personalized paths addressing individual arrhythmia substrates are needed in this specific cohort of patients.

scholarly journals Relevance of comorbidities and antithrombotic medication as risk factors for reoperation in patients with chronic subdural hematoma

2021 ◽  
Author(s):  
Alexander Younsi ◽  
Lennart Riemann ◽  
Cleo Habel ◽  
Jessica Fischer ◽  
Christopher Beynon ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Multivariate Analyses ◽  
Independent Predictor ◽  
Perioperative Complications ◽  
Chronic Subdural Hematoma ◽  
Western Society ◽  
Increased Risk ◽  
Surgical Evacuation ◽  
Antithrombotic Medication ◽  
Univariate Analyses

AbstractIn an aging Western society, the incidence of chronic subdural hematomas (cSDH) is continuously increasing. In this study, we reviewed our clinical management of cSDH patients and identified predictive factors for the need of reoperation due to residual or recurrent hematomas with a focus on the use of antithrombotic drugs. In total, 623 patients who were treated for cSDH with surgical evacuation between 2006 and 2016 at our department were retrospectively analyzed. Clinical and radiological characteristics and laboratory parameters were investigated as possible predictors of reoperation with univariate and multivariate analyses. Additionally, clinical outcome measures were compared between patients on anticoagulants, on antiplatelets, and without antithrombotic medication. In univariate analyses, patients on anticoagulants and antiplatelets presented significantly more often with comorbidities, were significantly older, and their risk for perioperative complications was significantly increased. Nevertheless, their clinical outcome was comparable to that of patients without antithrombotics. In multivariate analysis, only the presence of comorbidities, but not antithrombotics, was an independent predictor for the need for reoperations. Patients on antithrombotics do not seem to necessarily have a significantly increased risk for residual hematomas or rebleeding requiring reoperation after cSDH evacuation. More precisely, the presence of predisposing comorbidities might be a key independent risk factor for reoperation. Importantly, the clinical outcomes after surgical evacuation of cSDH are comparable between patients on anticoagulants, antiplatelets, and without antithrombotics.

scholarly journals Impact of Time Interval between Trauma Onset and Burr Hole Surgery on Recurrence of Late Subacute or Chronic Subdural Hematoma

2016 ◽  
Vol 59 (5) ◽  
pp. 498
Author(s):  
Dae-in Kim ◽  
Jae-hoon Kim ◽  
Hee-in Kang ◽  
Byung-gwan Moon ◽  
Joo-seung Kim ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Time Interval

scholarly journals Predictive value of diabetes mellitus for freedom from arrhythmia recurrence after cryoballoon-guided pulmonary vein isolation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
D Guckel ◽  
K Isgandarova ◽  
L Bergau ◽  
M El Hamriti ◽  
G Imnadze ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Structural Changes ◽  
Multivariate Analyses ◽  
Independent Predictor ◽  
Female Gender ◽  
Relevant Implication ◽  
Severe Arrhythmia ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Background Diabetes mellitus (DM) has been identified to play an important role in the regulation of atrial fibrillation (AF). Data concerning the impact of DM on the development of individual arrhythmia substrates are still lacking. Purpose Therefore, the primary aim of this study was to examine the outcome of cryoballoon-guided pulmonary vein isolation (PVI) in patients (pts) suffering from DM and coexisting AF. Methods 523 consecutive pts undergoing initial PVI using the 2nd generation cryoballoon were analysed. 273 pts (52%) suffered from paroxysmal AF (PAF) (51 ± 23.2 years old, 26% female), 250 pts (48%) from persistent AF (PERS) (63.9 ± 10.0 years old, 30% female) and 69 pts (13%) were diagnosed with DM (68 ± 19.6 years old, 30% female). Follow-up (FU) visits were performed at 3, 6 and 12 months including 7-day Holter ECGs. Primary endpoint was the first documented recurrence of any atrial arrhythmia after a 3 months blanking period (&gt; 30 sec.). Results Within the observation period of 12 months AF recurrence occurred in 29% (n = 151 pts). Regardless of the coincidence of DM, PAF pts were significantly younger than those with PERS (p = 0.001). PAF pts additionally suffering from DM presented with a significantly higher risk for arrhythmia recurrence (p = 0.047). Multivariate analyses verified DM as a strong independent predictor for arrhythmia recurrence associated with a &gt; 4 fold higher risk for recurrence after ablation (p = 0.009, hazard ratio (HR) 4.363, confidence interval (CI) 1.46-13.07). PERS pts showed a slightly increased rate of arrhythmia recurrence when additional DM was diagnosed. In these patients multivariate analyses revealed that DM was associated with a 43% higher risk for arrhythmia recurrence (p = 0.321, HR 1.143, CI 0.59-2.22). Beyond that, severe gender disparities were observed with female gender as independent predictor for arrhythmia recurrence (p = 0.027*, HR 1.927, CI 1.079-3.440). Conclusions DM has relevant implication for arrhythmia recurrence after PVI. More distinct effects were observed in PAF patients following AF ablation. This could be related to more severe arrhythmia substrates in PAF pts suffering from DM compared to PAF pts without additional DM and even more substantial structural changes in PERS. Thus, individual paths in ablation management are required in these pts with AF and coexisting DM.

scholarly journals Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

2020 ◽  
Author(s):  
FuMei Chen ◽  
Ke Wang ◽  
KangLi Xu ◽  
Li Wang ◽  
TianXiang Zhan ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Time Interval ◽  
Multiple Logistic Regression ◽  
Regression Analyses ◽  
Anticoagulant Drug ◽  
The Mean ◽  
Mean Time

Abstract Objective To investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage. Methods A multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019. Results A total of 448 CSDH patients were enrolled in the study. CSDH recurrence occurred in 60 patients, with a recurrence rate of 13.4%. The mean time interval between initial burr hole drainage and recurrence was 40.8±28.3 days. Postoperative AIH developed in 23 patients, with an incidence of 5.1%. The mean time interval between initial burr hole drainage and postoperative AIH was 4.7±2.9 days. Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH. Conclusions This study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

Efficacy of antiseizure prophylaxis in chronic subdural hematoma: a cohort study on routinely collected health data

2020 ◽  
Vol 132 (1) ◽  
pp. 284-288 ◽  
Author(s):  
Pascal Lavergne ◽  
Moujahed Labidi ◽  
Marie-Christine Brunet ◽  
Paule Lessard Bonaventure ◽  
Akli Zetchi ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Multivariate Analyses ◽  
Chronic Subdural Hematoma ◽  
Outcome Data ◽  
Primary Objective ◽  
Quebec City ◽  
Factors Associated ◽  
Routinely Collected Health Data ◽  
Clinical And Radiological Outcome ◽  
Univariate Analyses

OBJECTIVEChronic subdural hematoma (CSDH) is a common neurosurgical condition that can result in significant morbidity. The incidence of epileptic events associated with CSDH reported in the literature varies considerably and could potentially increase morbidity and mortality rates. The effectiveness of antiepileptic prophylaxis for this indication remains unclear. The primary objective of this study was to assess the relevance of anticonvulsant prophylaxis in reducing seizure events in patients with CSDH.METHODSAll consecutive cases of CSDH from January 1, 2005, to May 30, 2014, at the Hôpital de l’Enfant-Jésus in Quebec City were retrospectively reviewed. Sociodemographic data, antiepileptic prophylaxis use, incidence of ictal events, and clinical and radiological outcome data were collected. Univariate analyses were done to measure the effect of antiepileptic prophylaxis on ictal events and to identify potential confounding factors. Multivariate logistic regression was performed to evaluate factors associated with epileptic events.RESULTSAntiepileptic prophylaxis was administered in 28% of the patients, and seizures occurred in 11%. Univariate analyses showed an increase in the incidence of ictal events in patients receiving prophylaxis (OR 5.92). Four factors were identified as being associated with seizures: septations inside the hematoma, membranectomy, antiepileptic prophylaxis, and a new deficit postoperatively. Antiepileptic prophylaxis was not associated with seizures in multivariate analyses.CONCLUSIONSAntiepileptic prophylaxis does not seem to be effective in preventing seizures in patients with CSDH. However, due to the design of this study, it is difficult to conclude definitively about the usefulness of this prophylactic therapy that is widely prescribed for this condition.

scholarly journals Study of predisposing risk factors and etiology of chronic subdural hematoma in clipped patients of unruptured intracranial aneurysms – an institutional experience

2017 ◽  
Vol 31 (4) ◽  
pp. 526-529
Author(s):  
T. Kawase ◽  
Ahmed Ansari ◽  
Yoko Kato ◽  
Yasuhiro Yamada ◽  
Riki Tanaka
Keyword(s):  
Risk Factors ◽  
Subdural Hematoma ◽  
Intracranial Aneurysms ◽  
Chronic Subdural Hematoma ◽  
Emergency Evacuation ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Anticoagulant Drugs ◽  
Institutional Experience ◽  
Male Patients

AbstractIntroduction: Chronic subdural hematoma in clipped patients of unruptured intracranial aneurysms might lead to sudden neurological deterioration and may need emergency evacuation. We studied the effects of various factors in its etiology. Materials and methods: A retrospective study of 91operated clipped patients of unruptured aneurysms in the year 2014-2015 was taken. Various predisposing factors were studied. Results: Goreisan use was not associated with any reduction in post operative CSDH formation. Arachnoidoplasty and reduced post operative dead space contributed in a reduced formation of CSDH. Conclusion: Older male patients with aneurysms who had been treated with anticoagulant drugs should be considered candidates for additive ARP to prevent the development of postoperative CSDH.

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.

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