Chronic subdural haematoma (CSDH) is a typical disease in elderly patients and encountered frequently in neurosurgical practice. With an increasing number of elderly people in the general population, there is a need to investigate risk factors (age, falls, anticoagulant or antithrombotic therapy) which could be pertinent to the development of this disease. We reviewed 354 patients undergoing surgery for CSDH over a period of 7 years (1996)(1997)(1998)(1999)(2000)(2001)(2002), the occurrence being equally distributed over these years. CSDH occurred more often in elderly (≥65 years) than in younger people (69 vs 31%), and in men than in women (64 vs 36%). Falls were reported in 77% of patients. There was a trend towards a higher risk of falls in the elderly. Antithrombotic or anticoagulant therapy was present in 41% of patients, 32% of them having had falls. Overall postoperative mortality was 0% and overall recurrence rate 13.6%. CSDH in the elderly population, especially in men, is frequently associated with falls and anticoagulation or antithrombotic therapy. The indication for these medications, especially in elderly patients at risk for falls, should be carefully evaluated and controlled.
The value of cerebrospinal fluid (CSF) lactate level and CSF/blood glucose ratio for the identification of bacterial meningitis following neurosurgery was assessed in a retrospective study. During a 3-year period, 73 patients fulfilled the inclusion criteria and could be grouped by preset criteria in one of three categories: proven bacterial meningitis (n ؍ 12), presumed bacterial meningitis (n ؍ 14), and nonbacterial meningeal syndrome (n ؍ 47).
In patients with PD, results obtained under the specific conditions used suggest that neuronal activity in the amygdala and hippocampus is reduced. Assuming an impact on olfactory-related regions early in PD, our findings support the idea that selective impairment of these brain regions contributes to olfactory dysfunction. Furthermore, neuronal activity in components of the dopaminergic, cortico-striatal loops appears to be upregulated, indicating that compensatory processes are involved. This mechanism has not yet been demonstrated during olfactory processing in PD.
The role of aspirin as a risk factor in the occurrence of intracranial bleeding following head injury was investigated. Chronic subdural hematoma appears to be a suitable model for the evaluation of risk factors in the development of hemorrhage. The most common risk factors found in our study were, apart from age, chronic alcohol abuse (28%), consumption of cumarin-derivates (21%), aspirin (13%), and heparin (5%). A patient undergoing aspirin treatment must be considered at risk of development of chronic subdural hematoma. Aspirin should not be prescribed to patients with post-traumatic headaches.
We have evaluated the incidence of bleeding complications using miniheparin (2 X 2500 IU daily)-dihydroergotamine starting preoperatively in a randomized, controlled, prospective, double-blind study in 50 patients undergoing herniated lumbar disc operations. There was no difference in the incidence of intraoperative bleeding problems between the two groups. Preoperatively, 13 patients have been treated in another hospital with conventional low-dose heparin, and of these 13 patients, 7 developed bleeding complications. There were two deep wound hematomas in the placebo group. Early removal of stitches or operative revision of the wound was not necessary in either group. We conclude that the use of minidose heparin-dihydroergotamine is feasible for the prevention of thromboembolic complications in patients undergoing herniated lumbar disc operations, since an increased incidence of bleeding complications was not observed. This preventive method should therefore be further clinically evaluated.
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