Acute subdural hematomas: an age-dependent clinical entity

Abstract

Reports prior to 1980 describe overall mortality rates for acute subdural hematomas (SDH's) ranging from 40% to 90% with poor outcomes observed in all age groups. Recently, improved results have been reported with rapid diagnosis and surgical treatment. A relatively large number of older patients (34 patients over 65 years old) were treated recently at Harborview Medical Center, enabling a retrospective comparison with similarly treated younger patients (33 patients aged 18 to 40 years). Clinical information and computerized tomography morphometric data were obtained. Patients in the younger group were most often injured in motor-vehicle accidents (15 cases), whereas falls were most frequent in the older group (19 cases). Patients in both groups were rapidly resuscitated in the field; more than 30% were treated within 1 hour after the time of injury. Injury severity, determined by the admission Glasgow Coma Scale score, was similar for the two groups. Mean acute SDH volume was significantly larger in the older patients than in the younger group (mean +/- standard deviation: 96.2 +/- 117.2 vs. 21.6 + 27.7 cu cm), as was the amount of midline shift (1.2 +/- 1.69 vs. 0.6 +/- 0.75 cm). Surgical treatments were similar, but outcomes were dramatically different for the younger and older patients. Mortality rates were more than four times higher in older patients than in younger ones (74% vs. 18%). Three older patients and 25 younger patients were functional survivors. Old age, a larger SDH volume, and a larger midline shift all correlated with a poor outcome. The results of this study suggest that the pathophysiology of acute SDH varies with age, and that currently employed resuscitation and treatment methods have differentially improved the outcome for younger patients.

Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

“…2,8,17,23 Furthermore, in contrast to other studies using survival rate as the main end point in elderly patients, we tried to be more precise by categorizing survivors as having a favorable or an unfavorable outcome, specifically referring to quality of life.…”

“…2,7,15,16,18,23 In reports from the 1980s and 1990s, mortality rates for aSDH patients older than 65 years of age range from 74% to 88%, indicating devastating outcomes. 2,8,14 Over time, improved medical developments and increasing health care resources could have changed the outcomes. 16,26,28 However, elderly patients over 80 years of age with isolated aSDH are rarely mentioned in studies.…”

“…The prognosis of aSDH depends on multiple factors such as patient age, clinical status, signs of cerebral herniation, hematoma size, type of treatment, seizures, and time until treatment; prognosis and functional outcome in elderly patients in particular remain unclear. 2,8,19,21,25,29 ABBREVIATIONS aSDH = acute subdural hematoma; EEG = electroencephalography; FU = 3-month follow-up; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; TBI = traumatic brain injury. OBJECTIVE Acute subdural hematoma (aSDH) is a common disease increasing in prevalence given the demographic growth of the aging population.…”

Microbleeds as a Prognostic Factor for Acute Subdural Hematoma

“…4,6) In some studies, SDH volume and midline brain shift have also been related to poor outcome. 4,9,14) This study is the first to report the effect of microbleeds on prognosis in patients with acute SDH. Our results support a previous study that reported a relationship between microbleeds and prognosis in patients with moderate and severe traumatic brain injury and diffuse axonal injury.…”

“…4,13) Prognostic indicators of acute SDH are age, Glasgow Coma Scale score, pupillary reactivity, SDH volume, and midline brain shift. 4,6,9,14) Microbleeds identified on T 2 *-weighted magnetic resonance (MR) images correlate with outcome in patients with diffuse axonal injury. 7,16,20) However, the relationship between microbleeds and prognosis in patients with acute SDH is not known.…”