Cerebral atrophy is associated with development of chronic subdural haematoma

Yang, Andrew; Balser, David; Mikheev, Artem; Offen, Shani; Huang, Jason H.; Babb, James S.; Rusinek, Henry; Samadani, Uzma

doi:10.3109/02699052.2012.698364

Cited by 87 publications

(67 citation statements)

References 25 publications

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“…Indeed, cerebral atrophy was found to be associated with the development of chronic SDH. 16 It is possible that our calculations of cerebral atrophy through indirect measures (CSF space rather than cerebral volume) might have been underestimations due to the space-occupying SDH. The administration of blood thinners was also not associated with an increased risk of deterioration.…”

Section: Discussionmentioning

confidence: 95%

Nonsurgical acute traumatic subdural hematoma: what is the risk?

Bajsarowicz

Prakash²,

Lamoureux

et al. 2015

JNS

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T raumaTic subdural hematomas (SDHs) are a common pathological entity in neurosurgical practice. Between 12% and 29% of patients admitted with a severe traumatic brain injury (TBI) have an acute SDH. When combining all patients with TBI, 11% present with an SDH. 10 Acute traumatic SDH has been traditionally considered a lesion that should be treated surgically, although some might be approached conservatively. In a study by Wong, 17 a midline shift greater than 5 mm in patients with a Glasgow Coma Scale (GCS) score below 15 was associated with deterioration and the need for surgical evacuation. In another study, 11 it was the initial thickness of the SDH that was predictive of the need for surgery, with all SDHs greater than 10 mm in thickness requiring surgical evacuation. Based on these findings, Servadei et al.12 attempted to establish a treatment protocol for comatose patients with SDH. They selected 15 comatose patients with abbreviatioNs AUC = area under the curve; BCR = bicaudate ratio; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; ICP = intracranial pressure; ISS = Injury Severity Score; ROC = receiver operating characteristic; SDH = subdural hematoma; SFR = sylvian fissure ratio; TBI = traumatic brain injury. obJect The Brain Trauma Foundation has published guidelines on the surgical management of traumatic subdural hematoma (SDH). However, no data exist on the proportion of patients with SDH that can be selected for conservative management and what is the outcome of these patients. The goals of this study were as follows: 1) to establish what proportion of patients are initially treated conservatively; 2) to determine what proportion of patients will deteriorate and require surgical evacuation; and 3) to identify risk factors associated with deterioration and delayed surgery. methods All cases of acute traumatic SDH (869 when inclusion criteria were met) presenting over a 4-year period were reviewed. For all conservatively treated SDH, the proportion of delayed surgical intervention and the Glasgow Outcome Scale score were taken as outcome measures. Multiple factors were compared between patients who required delayed surgery and patients without surgery. results Of the 869 patients with acute traumatic SDH, 646 (74.3%) were initially treated conservatively. A good outcome was achieved in 76.7% of the patients. Only 6.5% eventually required delayed surgery, and the median delay for surgery was 9.5 days. Factors associated with deterioration were as follows: 1) thicker SDH (p < 0.001); 2) greater midline shift (p < 0.001); 3) location at the convexity (p = 0.001); 4) alcohol abuse (p = 0.0260); and 5) history of falls (p = 0.018). There was no significant difference in regard to age, sex, Glasgow Coma Scale score, Injury Severity Score, abnormal coagulation, use of blood thinners, and presence of cerebral atrophy or white matter disease. coNclusioNs The majority of patients with SDH are treated conservatively. Of those, only 6.5% later required surgery, for raised intracranial pressure or SDH pr...

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Section: Discussionmentioning

confidence: 95%

Nonsurgical acute traumatic subdural hematoma: what is the risk?

Bajsarowicz

Prakash²,

Lamoureux

et al. 2015

JNS

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“…Previously, we used a volumetric image analysis algorithm to determine the association between atrophy and subsequent cSDH 26 . Volumetric analysis was performed on CT scans acquired a mean of 209 days prior to cSDH diagnosis in 19 patients.…”

Section: Introductionmentioning

confidence: 99%

Evolving management of symptomatic chronic subdural hematoma: experience of a single institution and review of the literature

Balser

Rodgers

Johnson

et al. 2013

Neurological Research

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Objective-Chronic subdural hematoma has an increasing incidence and results in high morbidity and mortality. We review here the ten-year experience of a single institution and the literature regarding the treatment and major associations of chronic subdural hematoma (cSDH).Methods-We retrospectively reviewed all cSDHs surgically treated from 2000 to 2010 at our institution to evaluate duration from admission to treatment, type of treatment, length of stay in critical care, length of stay in the hospital and recurrence. The literature was reviewed with regards to incidence, associations and treatment of cSDH. [2000][2001][2002][2003][2004][2005][2006][2007][2008]44 patients were treated with burr holes. From 2008 to 2010, 29 patients were treated with twist drill evacuation (SEPS). 4 patients from each group were readmitted for reoperation (9% vs. 14%; p=.53). The average time to intervention for SEPS (11.2±15.3 hrs) was faster than for burr holes (40.3±69.1 hrs) (p=.02). The total hospital LOS was shorter for SEPS (9.3±6.8 days) versus burr holes (13.4±10.2 days) (p=.04); both were significantly longer than for a brain tumor patient undergoing craniotomy (7.0±0.5 days, n=94, P<. 01). Results-FromConclusion-Despite decreasing lengths of stay over time as treatment for cSDH evolved from burr holes to SEPS, the length of stay for a cSDH is still greater than that of a patient undergoing craniotomy for brain tumor. We noted 11% recurrence in our series of patients, which included individuals who recurred as late as 3 years after initial diagnosis.

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“…Furthermore, cortical ischemia is known to cause parenchymal atrophy [18]. Combined with the expansion of the cranial vault, this atrophy may predispose to the development of cSDH [19]. It is unlikely that cerebral atrophy and cranial vault expansion are causative, but in the setting of ongoing venous hypertension they may predispose to the development of cSDH.…”

Section: Discussionmentioning

confidence: 99%

Delayed Chronic Subdural Hematoma after Total Cranial Vault Reconstruction for Sagittal Synostosis

et al. 2018

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When diagnosed and treated after the first year of life, the surgical management of sagittal synostosis typically necessitates total cranial vault reconstruction. The safety of total cranial vault reshaping has improved greatly over the past 3 decades. We report on the first published case of an asymptomatic 5-year-old patient who was found to have a large left sided chronic subdural hematoma 4 months after total cranial vault reshaping requiring surgery, detected on routine imaging. We hypothesize that augmentation of venous blood egression through the emissary veins during surgery may have led to venous hypertension and subsequently the development of the chronic subdural hematoma.

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Cerebral atrophy is associated with development of chronic subdural haematoma

Cited by 87 publications

References 25 publications

Nonsurgical acute traumatic subdural hematoma: what is the risk?

Nonsurgical acute traumatic subdural hematoma: what is the risk?

Evolving management of symptomatic chronic subdural hematoma: experience of a single institution and review of the literature

Delayed Chronic Subdural Hematoma after Total Cranial Vault Reconstruction for Sagittal Synostosis

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