Risk Factors for Chronic Subdural Hematoma after a Minor Head Injury in the Elderly: A Population-Based Study

Tseng, Jen-Ho; Tseng, Ming-Yuan; Liu, Ann‐Jeng; Lin, Wei; Hu, Hsiao-Yun; Hsiao, Sheng-Huang

doi:10.1155/2014/218646

Cited by 33 publications

(16 citation statements)

References 11 publications

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“…2 More than 80% of patients with CSDH have a history of traumatic brain injury. 3 The current treatment for CSDH is surgery to remove the hematoma, 4 but the surgery carries a recurrence rate of approximately 25.6% in high-risk patients 5 and a mortality rate of 24% to 32% in elderly patients. 6 An overall mortality rate of 38.4% is reported for patients 90 years or older, independent of treatments.…”

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confidence: 99%

Safety and Efficacy of Atorvastatin for Chronic Subdural Hematoma in Chinese Patients

Jiang¹,

et al. 2018

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IMPORTANCE Chronic subdural hematoma (CSDH) is a trauma-associated condition commonly found in elderly patients. Surgery is currently the treatment of choice, but it carries a significant risk of recurrence and death. Nonsurgical treatments remain limited and ineffective. Our recent studies suggest that atorvastatin reduces hematomas and improves the clinical outcomes of patients with CSDH.OBJECTIVE To investigate the safety and therapeutic efficacy of atorvastatin to nonsurgically treat patients with CSDH. DESIGN, SETTING, AND PARTICIPANTSThe Effect of Atorvastatin on Chronic Subdural Hematoma (ATOCH) randomized, placebo-controlled, double-blind phase II clinical trial was conducted in multiple centers in China from February 2014 to November 2015. For this trial, we approached 254 patients with CSDH who received a diagnosis via a computed tomography scan; of these, 200 (78.7%) were enrolled because 23 patients (9.1%) refused to participate and 31 (12.2%) were disqualified.INTERVENTIONS Patients were randomly assigned to receive either 20 mg of atorvastatin or placebo daily for 8 weeks and were followed up for an additional 16 weeks. MAIN OUTCOMES AND MEASURESThe primary outcome was change in hematoma volume (HV) by computed tomography after 8 weeks of treatment. The secondary outcomes included HV measured at the 4th, 12th, and 24th weeks and neurological function that was evaluated using the Markwalder grading scale/Glasgow Coma Scale and the Barthel Index at the 8th week.RESULTS One hundred ninety-six patients received treatment (169 men [86.2%]; median [SD] age, 63.6 [14.2] years). The baseline HV and clinical presentations were similar between patients who were taking atorvastatin (98 [50%]) and the placebo (98 [50%]). After 8 weeks, the HV reduction in patients who were taking atorvastatin was 12.55 mL more than those taking the placebo (95% CI, 0.9-23.9 mL; P = .003). Forty-five patients (45.9%) who were taking atorvastatin significantly improved their neurological function, but only 28 (28.6%) who were taking the placebo did, resulting in an adjusted odds ratio of 1.957 for clinical improvements (95% CI, 1.07-3.58; P = .03). Eleven patients (11.2%) who were taking atorvastatin and 23 (23.5%) who were taking the placebo underwent surgery during the trial for an enlarging hematoma and/or a deteriorating clinical condition (hazard ratio, 0.47; 95% CI, 0.24-0.92; P = .03). No significant adverse events were reported.CONCLUSIONS AND RELEVANCE Atorvastatin may be a safe and efficacious nonsurgical alternative for treating patients with CSDH.

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confidence: 99%

Safety and Efficacy of Atorvastatin for Chronic Subdural Hematoma in Chinese Patients

Jiang¹,

et al. 2018

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“…A nationwide populationbased study in Taiwan, showed that old age (≥75 years), male gender, and coexisting hydrocephalus are significantly predictive factors, irrespective to their medical co morbidities. [3] However, in this case, the victim was a 42 year old adult female with no significant past medical or surgical history. After 15 days of the incident, she developed sudden onset bilateral lower limb weakness.With time, the acute SDH gets organised.…”

Section: Discussionmentioning

confidence: 83%

A case of chronic subdural haemorrhage and its medico-legal implication

2017

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Subdural haemorrhage is almost always traumatic and rarely natural. Traumatic Subdural haemorrhage (SDH) occurs following break of the parasagittal bridging vessels due to shearing movement of the head. Clinical features appear in 3 days in acute SDH, in 3 days to 3 weeks in sub-acute SDH and after 3 weeks in chronic SDH. SDHs are aged macroscopically and histopathologically. A 42 years old female knocked down by a bus was admitted to a base hospital. She was unconscious on admission and had nausea, vomiting and headache. By the next day, almost all symptoms were settled except headache and was discharged. Fifteen days later, she developed sudden onset bilateral lower limb weakness and was re-admitted. She was transferred to a tertiary care hospital immediately. The pre-op CT scan showed left frontal chronic subdural hemorrhage (SDH) and the patient was subjected to a burr hole surgery. She was transferred back to the base hospital and according to the medico-legal examination performed 21 days after the incident, the category of hurt was -fatal in the ordinary course of nature‖. In the remarks column, it was mentioned that it is not clear whether this SDH is due to the fall from the bus or any other incident after that. This chronic SDH also could be following a separate -new incident‖ that took place after the traffic accident. Therefore, without dating the chronic SDH accurately, it is not safe to identify the real causative circumstance.

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“…Early recognition of CSDH is important for early management. However, manifestations of CSDH are nonspecific and subtle (8,9).…”

Section: Discussionmentioning

confidence: 99%

Differential diagnostic problems in elderly chronic subdural hematoma patients

Münteanu¹,

Luca-Husti²,

Coman³

et al. 2016

Romanian Neurosurgery

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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.

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Risk Factors for Chronic Subdural Hematoma after a Minor Head Injury in the Elderly: A Population-Based Study

Cited by 33 publications

References 11 publications

Safety and Efficacy of Atorvastatin for Chronic Subdural Hematoma in Chinese Patients

Safety and Efficacy of Atorvastatin for Chronic Subdural Hematoma in Chinese Patients

A case of chronic subdural haemorrhage and its medico-legal implication

Differential diagnostic problems in elderly chronic subdural hematoma patients

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