scholarly journals Use of atorvastatin on pacients with chronic subdural haematoma: an integrative review

2021 ◽  
Author(s):  
Nathan Isaac Grassi Evangelista ◽  
Matheus Antonio Traldi ◽  
Bianca de Oliveira Sousa ◽  
Emanuella Campaner Zanotti ◽  
Arthur Dal Fabbro Chocair ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Surgical Intervention ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Chronic Subdural Haematoma ◽  
Integrative Review ◽  
Neurological Deficits ◽  
Atorvastatin Treatment ◽  
Effect Of Treatment ◽  
The Common

Background: Chronic subdural hematoma (CSDH) tends to occur more commonly in elderly patients, usually develops after mild head trauma and the common treatment is surgical. Objective: To evaluate the effect of treatment with atorvastatin compared to surgical intervention in elderly people with CSDH. Design and setting: we performed an integrative review of studies available in four databases from 2010 to 2020. Methods: Studies were considered eligible for this review if they were randomized controlled trials comparing the use of atorvastatin treatment to surgical treatment associated with drainage trepanation in elderly patients diagnosed with CSDH. Results: titles and abstracts were screened and 20 articles of those were selected to be fully read, of which 4 remained. To Sheng Qui et al (2017) and Chan et al (2016), the use of atorvastatin may be beneficial in the management of CSDH, so that the volume of the hematoma reduced from 48.70 ± 20.38 to 16.64 ± 14.28mL with a sample size of 22 in the first month of oral atorvastatin. Min Xu et al. (2016) and Wang et al. (2013), with a sample of 22, found improvements in 85.7% and 95.7% of patients with CSDH in terms of volume and neurological deficits presented. Conclusion: The treatment with atorvastatin appears to be safe and effective for CSDH compared to surgical intervention in the elderly. However, further studies are necessary to validate the results and, thus, to put the evidence into practice.

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 Hematoma - A Dilemma to Put Drain

2019 ◽  
Vol 9 (1) ◽  
pp. 26-32
Author(s):  
Md Amir Ali ◽  
Md Aminul Islam ◽  
RU Chowdhury ◽  
Ahmed Mursalin ◽  
Md Al Amin Salek ◽  
...  
Keyword(s):  
Closed System ◽  
Subdural Hematoma ◽  
Drainage System ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Chronic Subdural Haematoma ◽  
Burr Hole ◽  
Air Entrapment ◽  
Number Of Patients ◽  
Group A

Background: A chronic subdural hematoma (CSDH) is a collection of blood and blood breakdown products between the surface of the brain and its outermost covering the dura for more than 21 days. The elderly patients are more likely to develop a subdural hematoma, particularly from trivial trauma. CSDHs have been evacuated by burr holes, twist-drill craniotomies and craniotomies. The treatment of chronic subdural haematoma by burr hole drainage has been performed usually without using a closed drainage system, the problem of intracranial air entrapment still persists and can cause a deterioration in the level of consciousness or seizures in the postoperative period. We wanted to compare the effects of patient with drain and those without drain. Objectives: our study is to compare the clinical outcome of CSDH with or without drain. Methods: This prospective study was carried out at CMH Dhaka from January 2017 to July 2018; total 70 cases were investigated for the effectiveness of subdural drain. Cases were randomly allocated in two groups. Data were collected by specially designed questionnaire and analyzed by SPSS. Results and Observation: 70 patients of CSDH were included in this study out of which 25 underwent burr hole with closed system drainage and 45 underwent burr hole without closed system drainage. They were divided into Group A and B, respectively. Among the total number of patients 14 (20%) had shown recurrence. Out of 14 patients, 12 belong to Group B (86 %) and 2 belong to Group a (14 %). Conclusion: It is concluded that, those with a closed system drainage recurrence rate is significantly lower than with burr-hole evacuation alone. Bang. J Neurosurgery 2019; 9(1): 26-32

scholarly journals Functional recovery following surgery for chronic subdural hematoma

2020 ◽  
Vol 11 ◽  
pp. 450
Author(s):  
Sarah A. Merrill ◽  
Daniel Khan ◽  
Alexandra E. Richards ◽  
Maziyar A. Kalani ◽  
Naresh P. Patel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Physical Therapy ◽  
Functional Recovery ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Neurological Deficits ◽  
Presenting Symptoms

Background: Among the elderly, chronic subdural hematoma is a relatively common neurosurgical condition. Presenting symptoms range from headache and focal neurological deficits to seizure and coma depending on location and extent of brain compression. Functional recovery following surgery for chronic subdural hematoma is central to quality of life and ongoing health for elderly patients; however, there is a paucity of data regarding functional recovery in this population. Methods: In this study, the physical activity of patients who underwent surgical evacuation of chronic subdural hematoma was surveyed, as well as participation in physical therapy following surgery. In total, 38 patients completed the survey. Results: Of the 30 patients who exercised regularly before surgery, 28 (90.3%) returned to exercise within 1 year after surgery. Of 13 patients who reported playing hobby sports before surgery, 9 (69.2%) returned to those sports. 17/38 (44.7%) patients participated in physical therapy after surgery. 35/38 (92.1%) of patients reported that the surgery improved their quality of life. Conclusion: The majority of patients who underwent surgery for chronic subdural hematoma were able to return to exercise within 1 year. Participation in physical therapy was associated with return to exercise and sports. Further study is needed to determine which factors contribute to a return to baseline levels of physical activity following surgery for chronic subdural hematoma.

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.

Changes in Pharmacokinetics and Pharmacodynamics in the Elderly Patient

2007 ◽  
Vol 20 (1) ◽  
pp. 4-12 ◽  
Author(s):  
Lisa C. Hutchison ◽  
Catherine E. O'Brien
Keyword(s):  
Elderly Patient ◽  
Elderly Patients ◽  
The Elderly ◽  
Pharmacokinetic Parameters ◽  
Beers Criteria ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Drug Dosing ◽  
Central Nervous System Agents ◽  
The Common ◽  
Pharmacologic Agents

The use of pharmacologic agents in elderly patients is one of the most difficult aspects of patient care. An understanding of the common physiologic changes expected with aging is helpful to anticipate changes expected in pharmacokinetic parameters. Distribution, metabolism, and excretion are significantly altered for many drugs. In addition, pharmacodynamic variations in elderly patients may increase or decrease sensitivity to a medication independent of pharmacokinetic changes. These alterations are particularly noteworthy with cardiovascular and central nervous system agents. Current controversies regarding the application of estimation of renal function to drug dosing and use of the Beers criteria of medications potentially inappropriate in the elderly are discussed.

Geriatric head injuries - Experience and expectations

2008 ◽  
Vol 05 (02) ◽  
pp. 69-73 ◽  
Author(s):  
VD Sinha ◽  
Vishnu Gupta ◽  
Deepak Kumar Singh ◽  
Sanjeev Chopra ◽  
Pankaj Gupta ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Head Injuries ◽  
The Elderly ◽  
Chronic Subdural Haematoma ◽  
Trauma Patients ◽  
Good Recovery ◽  
Family Ties ◽  
Global Citizenry ◽  
Careful Assessment ◽  
Close Family

AbstractIt is widely known that global citizenry is continuing to age. The elderly head trauma patients, comprising 4.83% in our series are important from neurosurgical aspects. We conducted a study of elderly head injury patients admitted to our unit in last 11 years. Out of 620 patients, 423 males and 197 female, constituting a ratio of 2.1∶1. Fall constitutes the principle mode of injury (56.29%) followed by RTA (44.1%). We analyzed all the cases for surgical intervention after careful assessment of neurological condition. Amongst all cases operated for acute trauma, good recovery was seen in 51.8% and mortality in 41.7%, whereas in chronic subdural haematoma 84.2% cases showed good recovery as against mortality in 10.5%. In our society, due to very close family ties and desperation of family members to try active intervention even in patients with expected bleak outcome, we operated a fairly large number of cases and concluded that outcome was better after operative intervention.

scholarly journals Atorvastatin combined with dexamethasone in chronic subdural haematoma (ATOCH II): study protocol for a randomised controlled trial

2020 ◽  
Author(s):  
Rong Cai Jiang ◽  
Dong Wang ◽  
Shi Guang Zhao ◽  
Ren Zhi Wang ◽  
De Zhi Kang ◽  
...  
Keyword(s):  
Subdural Haematoma ◽  
Low Dose ◽  
Controlled Trial ◽  
Combined Treatment ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Chronic Subdural Haematoma ◽  
Efficacy And Safety ◽  
Double Blind ◽  
Haematoma Volume

Abstract Background Chronic subdural haematoma (CSDH) is a common condition in the elderly that often requires neurosurgical management. For small CSDH, evidence has emerged that statins may reduce haematoma volume and improve outcomes, presumably by reducing local inflammation and promoting vascular repair. We wish to extend this evidence in a study that aims to determine the efficacy and safety of atorvastatin combined with low-dose dexamethasone in patients with CSDH. Methods The second ATorvastatin On Chronic subdural Hematoma (ATOCH-II) study is a multi-center, randomized, placebo-controlled, double blind trial which aims to enroll 240 adult patients with a conservative therapeutic indication for CSDH, randomly allocated to standard treatment with atorvastatin 20 mg combined with low-dose dexamethasone (or matching placebos) daily for 28 days, and with 152 days of follow-up. The primary outcome is a composite good outcome defined by any reduction from baseline in haematoma volume and survival free of surgery at 28 days. Secondary outcomes include functional outcome on the modified Rankin scale (mRS) and modified Barthel Index at 28 days, surgical transition, and reduction in haematoma volumes at 14, 28 and 90 days. Discussion This multi-centre clinical trial aims to provide high-quality evidence on the efficacy and safety of the combined treatment of atorvastatin and low-dose dexamethasone to reduce inflammation and enhance angiogenesis in CSDH. Trial registration: ChiCTR, ChiCTR1900021659. Registered 3 March 2019, http://www.chictr.org.cn/showproj.aspx?proj=36157

scholarly journals Intervention in nursing care for the elderly patients with alzheimer: integrative review / Intervenções de enfermagem nos cuidados aos pacientes idosos com alzheimer: revisão integrativa / Intervención en la atención de enfermería para los pacientes...

2016 ◽  
Vol 5 (1) ◽  
pp. 84
Author(s):  
Luciana Póvoas Correa ◽  
Tayná Ramos Braga ◽  
Lucélia Cordeiro Malaquias ◽  
Maria Eliana Peixoto Bessa ◽  
Marilia Braga Marques
Keyword(s):  
Elderly Patients ◽  
Nursing Care ◽  
The Elderly ◽  
Integrative Review ◽  
Care For The Elderly

Objetivo: identificar as evidências na literatura sobre as intervenções de enfermagem em idosos com Alzheimer. Metodologia: trata-se de revisão integrativa da literatura. A coleta dos dados ocorreu nos meses de fevereiro a março de 2014 nas bases de dados MEDLINE e LILACS, sendo analisados 9 estudos. Resultados: as intervenções de enfermagem evidenciadas na literatura foram: atividades essenciais da vida diária; alimentação; aumento da socialização; melhora do sono; administração de medicamentos; musicoterapia; estimulação cognitiva; controle da dor; arteterapia. Conclusão: verificou-se a importância das intervenções ao longo dos dias de um idoso com Alzheimer e que essas melhoraram o estado geral dos idosos, diminuindo ou retardando o avanço da doença.

Outcome after resective epilepsy surgery in the elderly

2021 ◽  
pp. 1-10
Author(s):  
Attila Rácz ◽  
Kathryn Menne ◽  
Valeri Borger ◽  
Kevin G. Hampel ◽  
Hartmut Vatter ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Epilepsy Surgery ◽  
Seizure Control ◽  
Surgical Complication ◽  
The Elderly ◽  
Neurological Deficits ◽  
Control Group ◽  
Chi Square ◽  
Postoperative Seizure

OBJECTIVE The objective of this study was to compare complications, seizures, and neuropsychological outcomes after resective epilepsy surgery in patients ≥ 60 years of age who underwent operations to younger and matched controls. METHODS Charts of 2243 patients were screened for operated patients in the authors’ center between 2000 and 2015. Patients with available postsurgical follow-up data who were operated on at the age of 60 years or older and matched (by gender, histopathology, and side of surgery) controls who were between 20 and 40 years of age at the time of surgery were included. Outcomes regarding postoperative seizure control were scored according to the Engel classification and group comparisons were performed by using chi-square statistics. RESULTS Data of 20 older patients were compared to those of 60 younger controls. Postoperative seizure control was favorable in the majority of the elderly patients (Engel classes I and II: 75% at 12 months, 65% at last follow-up), but the proportion of patients with favorable outcome tended to be larger in the control group (Engel classes I and II: 90% at 12 months, p = 0.092; 87% at last follow-up, p = 0.032, chi-square test). The surgical complication rate was higher in the elderly population (65% vs 27%, p = 0.002), but relevant persistent deficits occurred in 2 patients of each group only. Neuropsychological and behavioral assessments displayed considerable preoperative impairment and additional postoperative worsening, particularly of verbal skills, memory (p < 0.05), and mood in the elderly. CONCLUSIONS The overall favorable postsurgical outcome regarding seizure control and the moderate risk of disabling persistent neurological deficits in elderly patients supports the view that advanced age should not be a barrier per se for resective epilepsy surgery and underscores the importance of an adequate presurgical evaluation and of referral of elderly patients to presurgical assessment.

Sign in / Sign up

Export Citation Format

Share Document