Acute-on-chronic subdural hematoma

Kloss, Brian T.; Lagace, Richard E.

doi:10.1007/s12245-010-0230-8

Cited by 20 publications

(11 citation statements)

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“…In these patients, computed tomography (CT) shows a fresh hematoma within the CSDH, and the fresh hematoma has both a higher and of relatively more uniform density in comparison to the surrounding CSDH. This condition is termed acute-on-chronic SDH, a type of SDH with unique characteristics 31 – 33) . Patients with acute-on-chronic SDH have more hemostatic complications and more unfavorable outcomes.…”

Section: Symptoms Of Csdh In Elderly Patientsmentioning

confidence: 99%

Chronic Subdural Hematoma in Elderly Patients: Is This Disease Benign?

Uno

Toi

Hirai

2017

Neurol. Med. Chir.(Tokyo)

118

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As the world population becomes progressively older, the overall incidence of chronic subdural hematoma (CSDH) is increasing. Peak age of onset for CSDH has also increased, and recently the 80-year-old level has a peak. Many patients with CSDH have had prior treatment with anticoagulants and antiplatelet drugs, which have an accompanying risk of CSDH. In elderly patients with CSDH, symptoms of cognitive change (memory disturbance, urinary incontinence, and decreased activity) and disturbance of consciousness at admission were more frequent compared to younger patients with CSDH. The literature actually offers conflicting advice regarding CSDH treatment; however, burr hole surgery with drainage under local anesthesia is the most common surgical procedure, even in elderly patients. The recurrence rate of CSDH has not decreased over recent decades, and it has ranged from 0.36–33.3%. Outcomes in patients over 75 years old was significantly worse than for those younger than 75. Moreover, long-term outcomes for elderly patients with CSDH are poor. CSDH in the elderly is no longer a benign disease. In the future, it will be important for us to understand the mechanisms of onset and recurrence of CSDH and to develop more effective medical treatments and noninvasive surgical techniques for elderly patients.

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Section: Symptoms Of Csdh In Elderly Patientsmentioning

confidence: 99%

Chronic Subdural Hematoma in Elderly Patients: Is This Disease Benign?

Uno

Toi

Hirai

2017

Neurol. Med. Chir.(Tokyo)

118

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“…Chronic haematomas are a mixture of liquefied blood and a semisolid clot pooling between the dura mater and the arachnoid mater [ 1 , 3 ]. Although the pathophysiology of ACSDH is complex and incompletely understood, it appears that rotational forces accompanying movement of the skull exert tensile strain and rupture of bridging veins leading to acute haemorrhaging into the subdural space [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Reoccurrence of Bleeding of a Chronic Subdural Haematoma Following a Fall

Carretero

2017

The Journal of Critical Care Medicine

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The case of a 60-year-old patient who presented with an acute-on-chronic subdural haematoma is reported. Chronic haematoma usually remains asymptomatic, and this is considered to be an unusual course of events. Trivial or minor injury may cause the cortical bridge veins and fragile vessels in the former haematoma to rupture with concomitant reoccurrence of bleeding. Old age, repeated traumatic brain injuries, brain atrophy, antiplatelet agents and oral anticoagulants such as warfarin are considered to be the underlying conditions to cause the reoccurrence of bleeding. However, our patient did not have any of those conditions.

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“…In this study, we found 8% of chronic SDH were actually acute-on-chronic SDHs. There are a few cases designated as acute-on-chronic SDH in the literature 5,8,9,16) . Curiously, it is hard to find any comments on the acute-on-chronic SDH, even in clinical series 3,12) reporting more than a thousand cases of chronic SDH.…”

Section: Discussionmentioning

confidence: 99%

Acute-on-Chronic Subdural Hematoma: Not Uncommon Events

Lee

Shim

Yoon

et al. 2011

J Korean Neurosurg Soc

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Objective : Patients with asymptomatic chronic subdural hematoma (SDH) are prone to fall or slip. Acute trauma on these patients may develop acute subdural bleeding over the chronic SDH. We recently experienced 9 patients with acute-on-chronic SDH. We report the clinical and radiological features of this lesion. Methods : We retrospectively examined the computed tomographic (CT) scans of 107 consecutive patients who diagnosed as chronic SDH from January 2008 to December 2010. All cases of CSDH were diagnosed on CT with or without MRI scan. Results : Acute-on-chronic SDH is not rare, being 8% of chronic SDH. The most common cause of trauma was a slip in drunken state. Alcoholism with multiple episodes of trauma was one of the prominent histories. Acute-on-chronic SDH appeared as a hyperdense layer of clot with irregular blurred margin or lumps in liquefied hematoma. Single or two burr holes was usually effective to remove the hematoma. Conclusion : Repeated trauma may cause acute bleeding over the chronic SDH. It will be helpful to understand the role of repeated trauma as a mechanism of hematoma enlargement.

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Acute-on-chronic subdural hematoma

Cited by 20 publications

References 0 publications

Chronic Subdural Hematoma in Elderly Patients: Is This Disease Benign?

Chronic Subdural Hematoma in Elderly Patients: Is This Disease Benign?

Reoccurrence of Bleeding of a Chronic Subdural Haematoma Following a Fall

Acute-on-Chronic Subdural Hematoma: Not Uncommon Events

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