Differential diagnostic problems in elderly chronic subdural hematoma patients

Abstract

Chronic subdural hematomas (CSDH) are recognized as common in older people (over 70 years). They are produced in minor injuries (falls on the same level). These CSDH have minor symptoms (headache, memory disorders, balance disorders, cognitive disorders, etc. and are classified as signs for the onset of dementia, circulatory failure -basilar vertebra, Alzheimer, etc. A simple brain CT scan can highlight these hematomas and a neurosurgical intervention will achieve extremely favorable prognosis. There are many pitfalls in the differential diagnosis of CSH especially with strokes being so common at this age.

Single versus double burr-hole drainage for chronic subdural hematoma: A study of relevant prognostic factors conducted in Pakistan

“…Chronic subdural hematoma (CSDH) is one of the most frequently encountered malady in neurosurgical clinics 1. It is generally considered as benign and easily treatable problem with an increasing incidence with age 2-4. If not timely diagnosed or treated, it carries significant morbidity or mortality and vice versa; and is also a treatable cause of stroke and dementia in peculiar groups.…”

“…If not timely diagnosed or treated, it carries significant morbidity or mortality and vice versa; and is also a treatable cause of stroke and dementia in peculiar groups. Majority being post-traumatic, often following minor head trauma,4 rest are mostly preceded by coagulation defects, intracranial hypotension, repeated intra cranial hemorrhage, increased outer membrane exudates, or occlusion of cerebrospinal fluid 1. Administration of anti-coagulants/antithrombotic drugs has been established as a vital iatrogenic factor 5.…”

“…It is a frequently missed clinical entity; those with modest symptoms (headaches, memory disorders, balance disorders, cognitive disorders etc.) are often misinterpreted as signs of dementia, circulatory failure-basilar vertebra or Alzheimer’s disease 4. The role of apt clinical assessment and radiological imaging to rule out CSDH cannot be overemphasized.…”

“…Diagnosis depends upon size of lesion and hematoma’s intima, history of fresh hemorrhage/hemolysis, and any associated primary or metastatic dural disease. Simple radiological scans like cerebral CT scans often highlight these hematomas; while early neurosurgical intervention validate favorable prognosis 1,4. When the cause is unknown, the color of the hematoma on neuroimaging study can hint towards duration of lesion.…”

“…Timely and optimum management averts grave complications 3. Treatment is aimed to return every patient to previous daily life, and is often achievable 4. A multitude of surgical drainage procedures are available but clear-cut guidelines are jeopardized and scanty.…”