Chronic Subdural Hematoma in the Elderly: A Curable Lesion

Abstract

Thirty‐nine elderly patients were treated surgically for chronic subdural hematoma. Of the 34 who survived the postoperative period, 30 were restored to their pre‐illness states of activity and function; the remaining 4 had paraplegia or hemiparesis. Chronic subdural hematoma in patients past 60 years of age presents many difficulties in diagnosis. However, clues often may be elicited by careful inquiry into the history, thorough physical examination, echo‐encephalography, plain roentgenograms of the skull, and analysis of the cerebrospinal fluid. Subdural hematoma must be seriously considered in any person older than 60 with a history of recent personality changes, rapidly progressing senility, headaches, or neurological deficits, whether or not there has been any known trauma to the head. It is important to recognize that the lesion is often curable. The better results in our series were obtained in those cases in which diagnosis and surgical intervention were carried out early in the course of the illness.

Gait Disorders in Older Adults

“…Despite similar methodological problems in these series, surgical removal of a chronic subdural hematoma results in marked improvement in unsteady gait and mental status 282–284 . Surgical treatment of CT‐diagnosed chronic subdural hematoma results in full recovery without deficit in 80% of patients, including reversal of hemiplegia and drowsiness (which might lead to a gait disorder) 285 …”

Chronic Subdural Hematoma in the Elderly: A Challenge in Diagnosis and Treatment

“…Relatives, well-intentioned or otherwise, provide further hurdles in the path of proper diagnosis and treatment; there are those who believe that any procedure might be meddlesome or even dangerous because of the age and general physical condition of the patient, and there are those who would seek psychiatric commitment of the patient purely for reasons of financial gain. On rare occasions, a referring physician is not familiar with the relative safety and accuracy of present-day methods of diagnosis (7) and the effectiveness and low risk of treatment (1,2,6).…”

Chronic Subdural Haematoma in the Aged

“…In the aged, the early diagnosis of subdural haematoma and subsequent surgical drainage involve a very good prognosis in the majority of cases (1, 2, 7). Sometimes there is spontaneous recovery (8, 9), and Bender (9) proposes such expectancy in selected cases of chronic subdural haematoma with a progressively favorable course.…”