Background: Bleedings are well known risks of both antiplatelet and anticoagulant therapy and both therapies have historically been considered as risk factors for CSDH. The aim of the study was to evaluate the association between exposure to anticoagulant/antiplatelet therapy and chronic subdural haematoma (CSDH).Methods: Single institution case-control study was conducted in patients older than 60 years who visited our academic tertiary care Emergency Department from January 2012 to December 2016. Patients with CSDH were identified by review of case and controls were selected with a 1:3 ratio for gender, age (60 years), year of admission and recent trauma.Results: There were 124 cases and 372 controls included in the study. Both anticoagulant and antiplatelet agents were associated with an increased risk of CSDH with an OR of 1.22 (CI 95% 0.66-1.54) and 1.12 (CI 95% 0.68-1.54), respectively. While OR was 1.11 (CI 95% 0.54-2.32), 1.21 (CI 95% 0.61-2.45), and 0.53 (CI 95% 0.33-0.78) for patients receiving oral anticoagulants, ADP-antagonists, and Cox-inhibitors, respectively. History of recent trauma was an effective modifier of the association between anticoagulants and CSDH. OR of 1.69 (CI 95% 0.99-2.96) was found for patients with history of trauma and OR of 4.27 (CI 95% 2.23-8.32) for patients without history of trauma.Conclusions: Anticoagulant and antiplatelet therapy have a significant association with an increased risk of CSDH. This association appears even stronger in those patients under anticoagulant therapy, who develop a CSDH in the absence of a recent trauma.
Background: The incidence of chronic subdural hematoma (CSDH) has been found to increasing in younger patients. This study was aimed to evaluate the role of outer membrane histopathology and comparison with the clinic-radiological aspects of chronic subdural hematoma in different age groups.Methods: Cases of CSDH admitted to the Neurosurgery department during January 2014 and December 2016 were included in the study. They were analyzed clinically, radiologically like site, size, thickness in computed tomography, the attenuation value and midline shift. Histopathological features were also recorded. Cases of acute and chronic sub dural hematoma which were managed conservatively irrespective of age and sex were excluded from the study.Results: Total 196 patients were included with median age of 66 yrs. The most common histopathological type of membrane was the scar inflammatory membrane (Type IV) in 43% of cases followed by hemorrhagic inflammatory membrane (Type III) in 31% of cases while the scar inflammatory type of membrane (Type II) was in 26% of cases. Young age group patient having less thickness of hematoma (<2cm) and having hyper density on CT scan. Old age group had more thickness(3.2cm) and mixed density with multiple layering.Conclusions: Young age group patient having less thickness of hematoma and hyper density compared to old age group. Recurrence and bilateral disease were more common in old age group associated with brain atrophy. Histopathological study completes the spectrum of CSDH in terms of severity of disease and overall prognosis of patient.
Objective:-Chronic subdural hematoma (CSDH) is a common disease among the elderly and with increasing incidence in the younger population, we have chosen to focus on CSDH in the different age groups so we can differentiate between presentation and radiological finding and etiological factor in each groups. Methods :-We conducted a retrospective review of 196 patients undergoing surgery for CSDH over a period of five years (2011-2016). Risk factors such as age, head trauma, anticoagulant and/or antiplatelet agent therapy and co-morbidity were investigated along with gender, laterality, surgical method and recurrence. We divided our patient in four groups according to age. Results:-Seventy-two percent of the patients were male and the mean age was 70% years (range 2-92 years). Headache was the most common symptom of presentation (63%). Maximum numbers of patients were found in the age group 61-75 years 74(38%). Association of head trauma in each group is the main etiological factor. CSDH is associated with brain atrophy in elderly and older age group. Conclusion :-Recurrence and bilateral disease are more common in old age group .Trauma to head is most common etiological factor in each age group .brain atrophy is etiological factor associated with old age group. Antiplatelet or anticoagulant therapy is associated as risk factor for the CSDH in all age groups.The use of antiplatelet or anticoagulant should be restricted to truly indicated patients.
To Study the effect of Cranioplasty on cerebral blood flow with clinical outcome in a patient who underwent decompressive craniectomy Aims: This study was done to evaluate the effect of cranioplasty on CBF with computed tomography perfusion (CTP). It also aimed to determine the correlation between postcranioplasty CBF and clinical outcome. Settings and Design: Prospective observational study. Subjects and Methods: All patients had CTP done to determine precranioplasty CBF. CTP was repeated at 6 weeks postcranioplasty and clinical assessment at 6 and 24 weeks postcranioplasty. Results: The median value of ipsilateral CBF was 52. 9and 64.10 ml/min/100 g at precranioplasty and postcranioplasty.contralateral CBF also showed improvement from 67.4 to 74. 7 ml/min/100 g at precranioplasty and postcranioplasty.contralateral. Median value for mini mental state examination showed a significant difference with value of 22, 25, and 25.5 at precranioplasty, 6 and 24 weeks postcranioplasty (P = 0.001 and P < 0.001). Median value for frontal assessment battery was 12, 14.5, and 15 (P = 0.002 and P = 0.001). Conclusions: Cranioplasty can improve cortical perfusion for both ipsilateral and contralateral hemisphere. Cranioplasty was observed to have a therapeutic role in terms of clinical outcome improvement.ce
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