Clinical Factors of Recurrent Chronic Subdural Hematoma.

Abstract

The clinical, radiological, and operative factors of recurrent chronic subdural hematoma (CSDH) were retrospectively analyzed in 116 patients with CSDH in 134 hemispheres, treated by one burr hole surgery. The correlation of recurrence was evaluated with personal and clinical factors such as age, sex, history of head injury, and interval from onset of initial symptoms to hospitalization; laboratory findings such as bleeding tendency and liver function; computed tomography (CT) findings such as hematoma density and brain atrophy; and operative findings such as additional procedures and postoperative residual air. The recurrence group (RG) included 10 hemispheres (7.5%) in 10 patients (8.6%). The interval from onset of symptoms to hospitalization was significantly shorter in the RG than in the nonrecurrence group (NRG). Headache was more frequently seen in the RG than in the NRG. Density of hematoma on CT was classified into five types: Low, iso, and high density, niveau, and mixed, and the incidence of recurrence was 0%, 2.3%, 17.2%, 12.5%, and 6.5%, respectively. Larger amounts of residual air in the postoperative hematoma cavity were associated with recurrence of CSDH. CSDH that progresses rapidly in the acute stage and appears as high density on preoperative CT is associated with a high incidence of recurrence. Intraoperative air invasion to the hematoma cavity should be avoided to prevent recurrence.

Clinical Analysis of Risk Factors Related to Recurrent Chronic Subdural Hematoma

“…Factors associated with patient characteristics, such as old age, brain atrophy, poor performance status on admission, bleeding tendency, kidney diseases, liver dysfunction, chronic alcoholism, diabetes, epilepsy, dementia, hemodialysis, use of anticoagulants, antiplatelet and chemotherapeutic agents, intracranial hypotension (cerebrospinal fluid shunt surgery), have commonly been reported 1,16,20) . Factors associated with the pathogenesis of CSDH include large hematoma, bilateral CSDHs, septum formation or multiple membranes in the hematoma cavity, mixed-density and high-density hematoma on the CT scan 2,9,10,12,14,20) .…”

“…Neomembrane in recurrent cases is vulnerable to repeat microbleeding into hematoma cavity over the short term. The density of CSDH reflects the proportion of fresh blood clots in hematoma cavity, and high density indicates that the hematoma involves in much fresh bleeding 16) . High proportion of fresh blood clots means the active growth of blood vessels into the membrane of CSDH.…”

“…Chronic subdural hematoma (CSDH) is one of the most frequent types of intracranial hemorrhage that is still associated with significant morbidity 7,16,20) . The CSDH is a common disease in elderly patients, and its incidence is highest in persons older than 70 years of age 17) .…”

Chronic Subdural Haematoma: Systematic Review Highlighting Risk Factors for Recurrent Bleeds

“…13,[23][24][25] These may be variably associated with head trauma, brain atrophy and decreased blood homeostasis. Seizures can be associated to the recurrence of CSDH due to the occasional head injury associated with certain types of seizures, or as a result of coagulopathy due to some anticonvulsants or to their effect on the liver causing disruption of the coagulation cascade.…”

Age Determination and Medicolegal Assessment in Chronic Subdural Hematoma: Case Report

“…[6][7][8][9][10][11][12][13][14] Travma ile KSDH arasında nedensellik bağı kurulurken, ayırıcı tanı yönünden diğer nedenlerin de araştırılarak dışlanması gereklidir. Bizim her iki olgumuzda KSDH'ye neden olabilecek medikolegal değerlendirmeye konu olan travmatik olay dışında diğer faktörlerin hiçbiri bulunmamaktadır.…”