Chronic Subdural Haematoma in the Elderly

Edlmann, Ellie; Hutchinson, Peter J.; Kolias, Angelos

doi:10.1007/978-3-319-40232-1_20

Cited by 3 publications

(3 citation statements)

References 67 publications

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“…1 A GOS stratified by SHE score. B GOS stratified by mSHE score rebleeding, respiratory failure, and dementia; this rate rises to up to 32% at 6 months, with iatrogenic complications such as pulmonary embolism, stroke, or myocardial infarction taking on a more predominant role due to the discontinuation of anticoagulants in a highly comorbid population [25]. These greatly differing mortality rates provide further explanation as to why pooling patients with these two separate clinical entities for prediction modeling might not be advisable.…”

Section: Discussionmentioning

confidence: 99%

A matter of frailty: the modified Subdural Hematoma in the Elderly (mSHE) score

2021

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The Subdural Hematoma in the Elderly (SHE) score was developed as a model to predict 30-day mortality from acute, chronic, and mixed subdural hematoma in the elderly population after minor or no trauma. Emerging evidence suggests frailty to be predictive of mortality and morbidity in the elderly. In this study, we aim to externally validate the SHE for chronic subdural hematoma (CSDH) alone, and we hypothesize that the incorporation of frailty into the SHE may increase its predictive power. A retrospective cohort of elderly patients with CSDH after minor or no trauma being treated at our institution was evaluated with the SHE. Thirty-day mortality and outcome were documented. Patients were assessed with the Clinical Frailty Scale (CFS), which was incorporated into a modified SHE (mSHE). Both the SHE and the mSHE were then assessed in their predictive powers through receiver operating characteristic statistics. We included 168 patients. Most (n = 124, 74%) had a favorable outcome at 30 days. Mortality was low at n = 7, 4%. The SHE failed to predict mortality (AUC = .564, p = .565). Contrarily, the mSHE performed well in both mortality (AUC = .749, p = .026) and outcome (AUC = .862, p < .001). A threshold of mSHE = 3 is predictive of mortality with a sensitivity of 50% and a specificity of 75% and of poor outcome with a sensitivity of 88% and a specificity of 64%. Frailty should be routinely evaluated in elderly individuals, as it can predict outcome and mortality, providing the possibility for medical, surgical, nutritional, cognitive, and physical exercise interventions.

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Section: Discussionmentioning

confidence: 99%

A matter of frailty: the modified Subdural Hematoma in the Elderly (mSHE) score

2021

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“…While high-energy trauma is typically required to cause SDH in younger individuals, in older individuals, SDH may result from minor trauma [ 7 ]. In such patients, any type of acceleration/deceleration injury may cause SDH [ 8 ], with up to half of older patients not having any direct head trauma [ 9 ]. Aside from trauma and older age, risk factors for SDH include coagulopathy, anticoagulant and antiplatelet medications, and alcoholism [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Concurrent Spinal and Intracranial Subdural Hematomas as a Cause of Near-Fatal Low Back Pain in the Chiropractic Office: A Case Report

Chu¹,

Trager²,

Nga³

et al. 2022

Cureus

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In older individuals, minor trauma may cause potentially fatal intracranial subdural hematoma (SDH). Rarely, these patients present with only low back and radicular pain as gravity redistributes the SDH to the lumbar spine.A 69-year-old male presented to a chiropractor with a 10-day history of acute on chronic low back pain, which radiated into his lower extremities bilaterally, involving weakness and difficulty walking, and a ground-level fall onto his elbows 16 days prior. He had visited his primary care provider, orthopedist, and traditional Chinese medicine practitioner, received oral analgesics and three ketorolac injections, and had lumbar radiographs, followed by acupuncture, cupping, and spinal manipulation without lasting relief. Considering the patient's concerning presentation, the chiropractor ordered lumbar magnetic resonance imaging (MRI) on the first visit, revealing findings suggestive of late subacute lumbar SDH, and recommended urgent brain MRI and neurosurgical referral. The patient went to an orthopedic surgeon at a nearby hospital, becoming disoriented upon presentation, prompting admission. Brain MRI confirmed bilateral chronic intracranial SDH, prompting emergency hematoma evacuation via burr hole craniostomy. The patient's gait rapidly improved, and the pain subsided over the following two weeks. This case highlights an older male identified as having spinal SDH by a chiropractor, leading to referral and surgery for concurrent life-threatening intracranial SDH. Clinicians should be aware that spinal SDH may stem from asymptomatic intracranial SDH and should be suspicious of SDH in older individuals after a fall, signs of which warrant emergency referral for MRI and surgical evaluation.

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“…Mortality ranges from 0% to 6%, whereas morbidity ranges from 0% to 76%. 3 In 60 to 80 percent of patients, a minor head injury is observed to precede the onset of CSDH. 4 Chronic alcohol use, anti-platelet intake, and oral anticoagulation medication are all predisposing variables in 21% of cases, anti-platelet intake in 11%, and oral anticoagulant therapy in 10% of cases, respectively.…”

Section: Introductionmentioning

confidence: 99%

Minimal Invasive Surgery for Chronic Subdural Hematoma

Rahman

Amir

Ali³

et al. 2021

Pak J Neurol Surg

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Objective: To assess significant improvement in terms of the Glasgow Coma Scale in patients subjected to minimally invasive surgery for a chronic subdural hematoma. Materials and Methods: A total of 80 patients with chronic subdural hematoma (CSDH) were enrolled in a sequential fashion using a retrospective study design. The patients were treated with minimally invasive surgery (MIS) and assessed at the end of the 2nd postoperative day (POD) for any significant improvement in the Glasgow coma scale (GCS). Results: There were 76.25% male and 23.75% female patients. A maximum number of patients (42.5%) were found with a GCS ranging from 9/15 – 11/15 (Class B) followed by Class A having GCS 12-13 (36.25%) and then Class C with GCS 5 – 8 (21.25% patients). In 86.2% and 13.7& of the patients, positive and negative outcomes were recorded. Maximum favorable surgical outcome was observed in 51-60 years of age group. In the majority of male patients, a favorable surgical outcome was reported. Similarly, a favorable surgical outcome was observed in Class B (GCS 9-11). There existed an insignificant difference between favorable surgical outcome vs. age groups, gender, and GCS class at baseline. Conclusion: This study found that CSDH using the MIS approach is linked to a high frequency of positive outcomes in terms of GCS improvement. A lower admission GCS score and older age are linked to a lower frequency of favorable outcomes and a higher likelihood of bad outcomes.

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Chronic Subdural Haematoma in the Elderly

Cited by 3 publications

References 67 publications

A matter of frailty: the modified Subdural Hematoma in the Elderly (mSHE) score

A matter of frailty: the modified Subdural Hematoma in the Elderly (mSHE) score

Concurrent Spinal and Intracranial Subdural Hematomas as a Cause of Near-Fatal Low Back Pain in the Chiropractic Office: A Case Report

Minimal Invasive Surgery for Chronic Subdural Hematoma

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