Chronic subdural haematoma in the elderly--a North Wales experience

Asghar, M.; Adhiyaman, Vedamurthy; Greenway, M W; Bhowmick, B K; Bates, Andrew

doi:10.1258/jrsm.95.6.290

Cited by 135 publications

(68 citation statements)

References 6 publications

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“…The incidence of cSDH increases greatly with age and ranges from approximately 3.4 per 100,000 in patients younger than 65 years of age, to 8 to 58 per 100,000 in those older than 65 years [4,7,12]. This age dependence is particularly relevant, as the latter population accounted for 35.9 million people in the United States or 12% of the overall population in 2003 [34], a number which is projected to rise to 72 million people (an estimated 20% of the overall population) by the year 2030 [34].…”

Section: Introductionmentioning

confidence: 99%

The surgical management of chronic subdural hematoma

et al. 2011

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Chronic subdural hematoma (cSDH) is an increasingly common neurological disease process. Despite the wide prevalence of cSDH, there remains a lack of consensus regarding numerous aspects of its clinical management. We provide an overview of the epidemiology and pathophysiology of cSDH and discuss several controversial management issues, including the timing of post-operative resumption of anticoagulant medications, the effectiveness of anti-epileptic prophylaxis, protocols for mobilization following evacuation of cSDH, as well as the comparative effectiveness of the various techniques of surgical evacuation. A PubMed search was carried out through October 19, 2010 using the following keywords: "subdural hematoma", "craniotomy", "burr-hole", "management", "anticoagulation", "seizure prophylaxis", "antiplatelet", "mobilization", and "surgical evacuation", alone and in combination. Relevant articles were identified and back-referenced to yield additional papers. A meta-analysis was then performed comparing the efficacy and complications associated with the various methods of cSDH evacuation. There is general agreement that significant coagulopathy should be reversed expeditiously in patients presenting with cSDH. Although protocols for gradual resumption of anti-coagulation for prophylaxis of venous thrombosis may be derived from guidelines for other neurosurgical procedures, further prospective study is necessary to determine the optimal time to restart full-dose anti-coagulation in the setting of recently drained cSDH. There is also conflicting evidence to support seizure prophylaxis in patients with cSDH, although the existing literature supports prophylaxis in patients who are at a higher risk for seizures. The published data regarding surgical technique for cSDH supports primary twist drill craniostomy (TDC) drainage at the bedside for patients who are high-risk surgical candidates with non-septated cSDH and craniotomy as a first-line evacuation technique for cSDH with significant membranes. Larger prospective studies addressing these aspects of cSDH management are necessary to establish definitive recommendations.

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Section: Introductionmentioning

confidence: 99%

The surgical management of chronic subdural hematoma

et al. 2011

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“…In 1657, J. J. Wepfer was the first to describe a CSDH, and in 1857, Virchow detailed the pathophysiology of this hematoma, naming it pachymeningitis haemorrhagica interna [1,7]. Many authors have since demonstrated that lesions are easily treated with minimal morbidity or mortality.…”

Section: Discussionmentioning

confidence: 99%

“…These drugs, which are used in a large proportion of the elderly population, may add to the risk of CSDH by as much as 42.5 times [19]. Some studies report that patients initially taking anticoagulant medications have more risk of recurrence and longer stays in the hospital [2,3,7,13,15,20]. Our results show only 3.5% of all CSDH patients admitted were chronically anticoagulated/antiaggregated or had coagulopathy history.…”

Section: Discussionmentioning

confidence: 99%

“…In our series, behavioral disturbances were more frequent in patients 65 years of age or older compared with younger patients who frequently presented with increased intracranial pressure (headache). Gelabert-González et al [3] and Asghar et al [7] reported that the most common clinical characteristics in elderly patients were mental disorders.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiological characteristics of 778 patients who underwent surgical drainage of chronic subdural hematomas in Brasília, Brazil

et al. 2013

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BackgroundChronic subdural hematomas (CSDHs) are common in neurosurgical practice. There are no publications that report large series of the epidemiological characteristics of this pathology in Brazil. The purpose is to describe a large series of surgical cases and analyze the epidemiological and clinical characteristics.MethodsWe retrospectively analyzed patients with CSDH admitted into Neurosurgical Services at the Hospital de Base do Distrito Federal, Brasília, Brazil from 2006 to 2011. Age, sex, clinical feature, etiology, surgical procedure, side, clinical outcome, and recurrence were reviewed. Statistical tests were used to analyze data, and P < 0.05 was considered statistically significant.ResultsThe series included 778 patients. There were 643 (82.6%) male patients with a mean age of 64.3 ± 15.9 (range, 14–93) years. The principal symptom was headache (58.9%). The most frequent origin was a fall (282 cases, 36.2%), but the origin remained unclear in 281 (36.1%) patients. Mild head injury occurred in 540 (69.4%) cases. Burr holes with drainage were used as the surgical procedure in 96.5% patients, and 687 (88.3%) patients had a positive outcome. Mortality was 0%. Recurrence was observed in 42 cases.ConclusionsThe occurrence of CSDHs is more common in elderly men. Treatment with burr holes and drainage is a simple and safe method for treatment. In our experience, CSDH presents decreased morbidity and mortality.

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“…It is mainly age dependent, with a 10-fold increase in patients aged >65 years (weighted average 0.026% per patient-year) [28,29,30]. Oral anticoagulants increase the risk by at least another 10-fold to 0.22-0.39% per patient-year, depending mainly on the level of the INR [31,32].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Long-Term Imatinib Therapy for Pulmonary Arterial Hypertension

et al. 2015

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Background: Antiproliferative strategies have emerged as a potential therapeutic option for pulmonary arterial hypertension (PAH). Objective: To evaluate the long-term efficacy and safety of imatinib. Methods: This is an observational study of 15 patients with idiopathic PAH (n = 13) or PAH associated with connective tissue disease (n = 2) treated off-label with imatinib 400 mg daily. Pulmonary hypertension-specific therapy was established in all patients (triple therapy in 10, dual therapy in 3, and monotherapy in 2 patients). Results: After 6 months, improvement in hemodynamics (p < 0.01), functional class (p = 0.035), and quality of life (p = 0.005) was observed. After a median follow-up of 37 months, there was a sustained improvement in functional class (p = 0.032), quality of life (p = 0.019), and echocardiographic parameters of right ventricular function (p < 0.05). Three patients (20%) presented with completely normal echocardiography, absent tricuspid regurgitation, and normal pro-brain natriuretic peptide levels, indicative of ‘hemodynamic remission'. Of note, however, only 1 case was assessed by invasive hemodynamics. The overall 1- and 3-year survival was 100 and 90%, respectively. Two patients experienced a subdural hematoma (SDH), which in both cases resolved without sequelae. After careful consultation of the potential risks and benefits, all patients as well as a safety cohort of 9 subsequent cases decided to continue the imatinib therapy. After adjusting the target international normalized ratio (INR) to around 2.0, no further cases of SDH occurred during 50 patient-years. Conclusions: Long-term treatment with imatinib may improve the functional class and quality of life. Single cases might even attain hemodynamic remission. The occurrence of 5% SDH per patient-years is concerning. However, adjusting the INR to around 2.0 might obviate this complication.

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Chronic subdural haematoma in the elderly--a North Wales experience

Cited by 135 publications

References 6 publications

The surgical management of chronic subdural hematoma

The surgical management of chronic subdural hematoma

Epidemiological characteristics of 778 patients who underwent surgical drainage of chronic subdural hematomas in Brasília, Brazil

Efficacy and Safety of Long-Term Imatinib Therapy for Pulmonary Arterial Hypertension

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