Chronic Subdural Haematoma in the Elderly—A North Wales Experience

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

doi:10.1177/014107680209500607

Cited by 71 publications

(109 citation statements)

References 7 publications

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“…The 30-day mortality of SDH in this population was 39%. The incidence rate for SDH in dialysis patients was 191 per 100,000 dialysis patients per year in 2002 as compared with three to 58 cases per 100,000 general population per year, reported from other studies worldwide (2)(3)(4)(5) (Figure 1).…”

Section: Resultsmentioning

confidence: 73%

“…Age has been reported in previous studies to be an independent risk factor for SDH (2-6). The incidence rate of SDH has been reported to be 3.4 per 100,000 general population per year for Ͻ65 years and a varying rate ranging from 8 to 58 per 100,000 per year in those Ͼ65 years of age (2)(3)(4). Even if all new dialysis patients were older than 65 years, the incidence rate of 200 per 100,000 of SDH in the dialysis population would still be well over that reported for the general population.…”

Section: Discussionmentioning

confidence: 99%

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Subdural Hematomas in Chronic Dialysis Patients

Sood¹,

Sinson²,

Cohen³

2007

Clinical Journal of the American Society of Nephrology

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Background and Objectives: Subdural hematoma is a known complication of long-term hemodialysis. Design, Setting, Participants, and Measurements: The US Renal Data System was used to determine the occurrence rate of nontraumatic subdural hematoma in long-term dialysis patients and to evaluate time trends.Results: The occurrence rate of subdural hematoma in long-term dialysis patients is 10 times higher than that of the general population. From 1991 to 2002, the occurrence rate of subdural hematoma in hemodialysis patients doubled, whereas it did not change in peritoneal dialysis patients.Conclusions: This high occurrence rate of subdural hematoma and its recent increase may be related to increased use of anticoagulants in long-term hemodialysis patients.Clin J Am Soc Nephrol 2: 956-959, 2007.

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Section: Resultsmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Subdural Hematomas in Chronic Dialysis Patients

Sood¹,

Sinson²,

Cohen³

2007

Clinical Journal of the American Society of Nephrology

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“…Similar likelihoods of return to functional baseline and nonsignificant differences in the rate and risk of mortality were unexpected, as past studies have demonstrated worse outcomes and higher mortality rates following neurotrauma in older patients than in younger patients. 3,12,13 Our findings suggest that advancements in the management of intracranial hematomas, particularly postoperative ICU care and rehabilitation, may mitigate the increased risk of death traditionally associated with older age in past studies. There is some literature that has supported these findings.…”

Section: Discussionmentioning

confidence: 74%

Postoperative outcomes following closed head injury and craniotomy for evacuation of hematoma in patients older than 80 years

Lau

El-Sayed

Ziewacz

et al. 2012

JNS

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Object Advances in the management of trauma-induced intracranial hematomas and hemorrhage (epidural, subdural, and intraparenchymal hemorrhage) have improved survival in these conditions over the last several decades. However, there is a paucity of research investigating the relation between patient age and outcomes of surgical treatment for these conditions. In this study, the authors examined the relation between patient age over 80 years and postoperative outcomes following closed head injury and craniotomy for intracranial hemorrhage. Methods A consecutive population of patients undergoing emergent craniotomy for evacuation of intracranial hematoma following closed head trauma between 2006 and 2009 was identified. Using multivariable logistic regression models, the authors assessed the relation between age (> 80 vs ≤ 80 years) and postoperative complications, intensive care unit stay, hospital stay, morbidity, and mortality. Results Of 103 patients, 27 were older than 80 years and 76 patients were 80 years of age or younger. Older age was associated with longer length of hospital stay (p = 0.014), a higher rate of complications (OR 5.74, 95% CI 1.29–25.34), and a higher likelihood of requiring rehabilitation (OR 3.28, 95% CI 1.13–9.74). However, there were no statistically significant differences between the age groups in 30-day mortality or ability to recover to functional baseline status. Conclusions The findings suggest that in comparison with younger patients, patients over 80 years of age may be similarly able to return to preinjury functional baselines but may require increased postoperative medical attention in the forms of rehabilitation and longer hospital stays. Prospective studies concerned with the relation between older age, perioperative parameters, and postoperative outcomes following craniotomy for intracranial hemorrhage are needed. Nonetheless, the findings of this study may allow for more informed decisions with respect to the care of elderly patients with intracranial hemorrhage.

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“…The reasons why this type of hematoma occurs frequently among the elderly include an increase in antithrombotic medications, venous fragility, augmentation of the subdural space, and an increased exposure to traumatic injury resulting from frequent falls 1) . For the initial management of CSDH, numerous surgical treatments have been proposed 5,14,15,18,21) .…”

Section: Introductionmentioning

confidence: 99%

Chronic Subdural Hematoma Treated by Small or Large Craniotomy with Membranectomy as the Initial Treatment

Kim

Kang

Kim

et al. 2011

J Korean Neurosurg Soc

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mostly liquefied CSDH. Conversely, craniotomy is generally accepted as the optimal approach for reaccumulation of a CSDH, existence of a solid hematoma, failure of brain reexpansion, or marked swelling subjacent to the hematoma 5,14) . The purpose of this study was to analyze the efficacy of small or large craniotomy with membranectomy as the initial treatment for CSDH. MATERIALS AND METHODSA retrospective study was performed using the medical records retained by our hospital. computed tomography (CT) scans were the primary imaging method for the evaluation of CSDH in all patients. The technique of a burr-hole with closed system drainage for 24 to 72 hours was chosen for cases of nonseptated and mostly liquefied CSDH. However, on the basis of CT and/or magnetic resonance imaging (MRI) findings, cases of CSDH demonstrating either mixed density or hyperdense lesions ( Fig. 1), intrahematomal membranes or web-like structures (Fig. 2), or an organized/calcified CSDHs (Fig. 3) were selected for craniotomy. We classified 317 patients with CSDH into three groups according to the extent of surgery required : group I, burr hole with drainage (n=259); group II, small crani- INTRODUCTIONChronic subdural hematoma (CSDH) represents one of the most frequent intracranial hemorrhages encountered in neurosurgical department, with elderly citizens being more frequently affected. The reasons why this type of hematoma occurs frequently among the elderly include an increase in antithrombotic medications, venous fragility, augmentation of the subdural space, and an increased exposure to traumatic injury resulting from frequent falls 1) . For the initial management of CSDH, numerous surgical treatments have been proposed 5,14,15,18,21) . However, the extent of surgical treatment required for CSDH is still controversial 2,24) , and the optimal treatment for CSDH is not well defined 16) . The choice of surgical technique for CSDH must be dictated by the degrees of organization of the hematoma. Burr-hole with drainage is mandatory for non-septated and Department of Neurosurgery, Seoul Medical Center, Seoul, KoreaObjective : There are few studies comparing small and large craniotomies for the initial treatment of chronic subdural hematoma (CSDH) which had non-liquefied hematoma, multilayer intrahematomal loculations, or organization/calcification on computed tomography and magnetic resonance imaging. These procedures were compared to determine which would produce superior postoperative results. Methods : Between 2001 and 2009, 317 consecutive patients were surgically treated for CSDH at our institution. Of these, 16 patients underwent a small craniotomy with partial membranectomy and 42 patients underwent a large craniotomy with extended membranectomy as the initial treatment. A retrospective review was performed to compare the postoperative outcomes of these two techniques, focusing on improvement of neurological status, complications, reoperation rate, and days of post-operative hospitalization. Results : The mean ages were 69.4±12.1 a...

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Chronic Subdural Haematoma in the Elderly—A North Wales Experience

Cited by 71 publications

References 7 publications

Subdural Hematomas in Chronic Dialysis Patients

Subdural Hematomas in Chronic Dialysis Patients

Postoperative outcomes following closed head injury and craniotomy for evacuation of hematoma in patients older than 80 years

Chronic Subdural Hematoma Treated by Small or Large Craniotomy with Membranectomy as the Initial Treatment

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