Clinical Course in Chronic Subdural Hematoma Patients Aged 18–49 Compared to Patients 50 Years and Above: A Multicenter Study and Meta-Analysis

Abstract

Objective: Chronic Subdural Hematoma (cSDH) is primarily a disease of elderly, and is rare in patients <50 years, and this may in part be related to the increased brain atrophy from 50 years of age. This fact may also influence clinical presentation and outcome. The aim of this study was to study the clinical course with emphasis on clinical presentation of cSDH patients in the young (<50 years). Methods: A retrospective review of a population-based cohort of 1,252 patients operated for cSDH from three Scandinavian neurosurgical centers was conducted. The primary end-point was difference in clinical presentation between the patients <50 y/o and the remaining patients (≥50 y/o group). The secondary end-points were differences in perioperative morbidity, recurrence and mortality between the two groups. In addition, a meta-analysis was performed comparing clinical patterns of cSDH in the two age groups. Results: Fifty-two patients (4.2%) were younger than 50 years. Younger patients were more likely to present with headache (86.5% vs. 37.9%, p < 0.001) and vomiting (25% vs. 5.2%, p < 0.001) than the patients ≥50 y/o, while the ≥50 y/o group more often presented with limb weakness (17.3% vs. 44.8%, p < 0.001), speech impairment (5.8% vs. 26.2%, p = 0.001) and gait disturbance or falls (23.1% vs. 50.7%, p < 0.001). There was no difference between the two groups in recurrence, overall complication rate and mortality within 90 days. Our meta-analysis confirmed that younger patients are more likely to present with headache ( p = 0.015) while the hemispheric symptoms are more likely in patients ≥50 y/o ( p < 0.001). Conclusion: Younger patients with cSDH present more often with signs of increased intracranial pressure, while those ≥50 y/o more often present with hemispheric symptoms. No difference exists between the two groups in terms of recurrence, morbidity, and short-term mortality. Knowledge of variations in clinical presentation is important for correct and timely diagnosis in younger cSDH patients.

Functional recovery following surgery for chronic subdural hematoma

“…One patient was excluded due to having acute-on-chronic presentation. Of 90 total identified cSDH patients, 31 were deceased during the follow-up period, which is consistent with mortality rates in other published series,[ 2 ] and another 9 patients were ineligible due to aforementioned criteria.…”

“…found 32% mortality rate at 12 months in elderly cSDH cohort with a mean age of 80. [ 2 ] Another study comparing the immediate postoperative period in patients below and above age 50 found that the older group had higher rates of surgical complications during evacuation of cSDH and during recovery. [ 6 ] Stippler et al .…”

“…Reported incidence of cSDH is between 1.72 and 20.6/100,000 persons per year across the study populations, with an increased incidence in patients over 60 years of age. [ 1 , 2 ] The underlying pathophysiology varies from damage to subdural bridging veins to inflammatory processes and osmotic oncotic pressure gradients, culminating in accumulation to periparenchymal fluid. [ 3 ] In addition, there have been case reports of cSDH developing due to dural metastases.…”

Development of the Chronic Subdural Hematoma Grading System to Predict Postoperative Recurrence

“…The clinical factors related to RrR were retrospectively analyzed in this study. As reported previously, age (> 65 years) was related to recurrence 3,12 . The imaging characteristics during the perioperative period play an important role in the assessment of the RrR.…”

Prevalence of Cognitive Complaints and Impairment in Patients with Chronic Subdural Hematoma and Recovery after Treatment: A Systematic Review

“…Young patients most often present with signs of increased intracranial pressure, such as progressive headache, nausea, and vomiting. 10,11 In older patients, ‡65 years of age, cognitive and mental changes are more prevalent. 12,13 In past decades, most studies on CSDH focused on surgical techniques, risk factors for the development of CSDH, perioperative use of anticoagulants, or optimal treatment modalities.…”