Epidemiology of chronic subdural haematoma

Foelholm, R; Waltimo, O.

doi:10.1007/bf01405457

Cited by 219 publications

(109 citation statements)

References 3 publications

(2 reference statements)

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“…Em relação à idade, tanto a média (52 anos) quanto a mediana (57 anos) revelaram valores discretamente inferiores aos encontrados nos estudos reali- A associação entre traumatismo cranioencefálico e hematoma subdural crônico neste estudo foi de 74,8%, estando de acordo com estudos anteriores que mostravam uma associação com variação entre 57% e 77% 1,7,[13][14][15]18,20,21 . O uso de anticoagulante oral ou anti-agregante plaquetário foi encontrado em apenas 3,2% dos pacientes estudados, confirmando também estudos anteriores em que a proporção desses pacientes variava entre 2% e 24% 1,4,7,15,18,19 .Os pacientes com antecedente de alcoolismo representaram 14,2% dos pacientes estudados e a literatura mostra uma variação de 14% até 50% 1,7,15,16 .…”

Section: Discussionunclassified

“…A mortalidade neste estudo foi 9,3%, valor que também coincide com os encontrados anteriormente, que variavam de 0,5% a 15,6% [13][14][15]18,19 . Os pacientes com alterações de coagulação nos exames pré-operatórios tanto de RNI (>1,25) quanto de plaquetas (<150,000/mm 3 ) apresentaram maior frequência de óbitos, com r<0,001 e r<0,004 respectivamente.…”

Section: Discussionunclassified

“…Estudos enfatizam também a atividade anticoagulante da trombomodulina expressa nos vasos sinusoidais quando estes são lesados, contribuindo para a perpetuação dos microssangramentos 11 . Os fatores associados incluem alcoolismo crônico, implante de shunts ventriculares, distúrbios de coagulação, epilepsia e trauma 1,3,[7][8][9][13][14][15][16][17] . A maioria dos pacientes se encontra a partir da terceira década 15 com maior incidência entre quinta e sexta décadas [13][14][15]18 , sendo que os homens são mais comumente afetados pela patologia que as mulheres 1,7,[14][15][16] .…”

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Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma

Yasuda

Morita

Nishimori

et al. 2003

Arq. Neuro-Psiquiatr.

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RESUMO -O objetivo deste estudo é analisar a evolução de pacientes com hematoma subdural crônico em relação aos achados do coagulograma. Foram analisados 161 pacientes operados no Hospital das Clínicas-UNICAMP entre abril de 1994 e 2000. Foi detectado um predomínio do sexo masculino (86,3%), da cor branca (85,1%) e da faixa etária na quinta década (mediana 57 anos). O estudo mostrou mortalidade maior no período pós-operatório entre os pacientes com valores de RNI (international normalized ratio) superiores a 1,25 e/ou trombocitopenia (p<0,001 e p=0,004, respectivamente) e mortalidade menor para os pacientes com antecedente de traumatismo cranioencefálico (76%) (p=0,044). Os resultados ressaltam a importância da avaliação pré-operatória com o coagulograma a fim de se corrigir possíveis alterações.PALAVRAS-CHAVE: hematoma subdural crônico, coagulação, mortalidade. Chronic subdural hematoma: study of 161 patients and the relationship with coagulation abnormalitiesABSTRACT-The chronic subdural hematoma represents one of the most frequent types of intracranial hemorrhage. One hundred sixty one patients operated in the Clinical Hospital of State University of Campinas -SP (UNICAMP) from April 1994 to May 2000, were analyzed retrospectively in order to characterize the population and to study the importance of the pre-operative coagulation analysis in the outcome. The majority of the population was male (86%), white (85.1%) and in the fifth decade (median age: 57 years). A high mortality index in the postoperative period was found in patients with INR (international normalized ratio) values greater than 1.25 and/or thrombocytopenia (p<0.001 and p=0.004 respectively). Patients with previous head injury history (76%) showed a lower mortality (p=0.044). The results stand out the importance of the pre-operative evaluation with coagulation studies in order to correct possible abnormalities.KEY WORDS: chronic subdural hematoma, coagulation, mortality. O hematoma subdural crônico (HSC) representa uma das formas mais frequentes de hemorragia intracraniana 1 e é considerado uma lesão benigna, ainda que cronicamente progressiva 1-3 . O maior acometimento de pacientes idosos leva a uma variedade de dificuldades diagnósticas e terapêuticas devido a inespecificidade dos sintomas bem como patologias associadas 1,4 . Na maioria dos casos a evolução sem a instituição do tratamento cirúrgico pode ser fatal tanto pela compressão cerebral exercida pelo hematoma quanto pelas doenças associadas 5 . Por outro lado o diagnóstico precoce e a drenagem cirúrgica permitem a recuperação completa na maioria dos casos 1 .O HSC é caracterizado por uma coleção encapsulada e bem delimitada entre a dura máter e a membrana aracnóide contendo uma mistura de sangue fluido e coagulado de vários estágios 5,6 . A fisiopatologia do hematoma subdural crônico tem sido alvo de estudos desde a publicação de Virchow em 1857, em que descrevia com detalhes a lesão como uma paquimeningite hemorrágica 2,7,8 . Apesar das diversas teorias desenvolvidas desde então, a su...

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Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma

Yasuda

Morita

Nishimori

et al. 2003

Arq. Neuro-Psiquiatr.

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“…26 While the width of the hematoma is often determined at the level of the maximum thickness of the clot, it has been reported to be associated with the patient age, with the underlying atrophy of the aging brain providing the space for the hematoma to grow and/or recur. 27 This may also lead to poor brain re-expansion after the operation. Poor brain re-expansion has been correlated with recurrence in previous reports.…”

Section: -22mentioning

confidence: 99%

Chronic Subdural Haematoma: Systematic Review Highlighting Risk Factors for Recurrent Bleeds

Abdelsadg¹,

Kanodia²,

Abbas³

et al. 2017

Neuro – Open Journal

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Citation Systematic ReviewPage 16 ABSTRACTIntroduction: Chronic subdural haematoma (CSDH) is one of the commonest forms of intracranial haemorrhage. Surgical drainage of CSDH is a routine operation in the modern neurosurgical practice which has shown to be the most effective way in treating this entity; however, the incidence of recurrence of the haematoma post operatively remains as high as 26.5%. The risk factors for CSDH recurrence remains an area of ongoing research. Objective: We have conducted a systematic review to evaluate the available literature addressing the risk factors for CSDH recurrence, aiming to minimise or at least identify patients at higher risk of recurrence in order to decrease associated morbidity. Methods: Ovid via Medline, PubMed, and Google scholar databases were searched for eligible studies, search results were then limited to studies in English language, Humans and studies published within the last 5 years. The included studies were critically appraised using the Critical Appraisal Skills Programme (CASP) tool, and each study has then been ranked using the Harbour and Miller hierarchy of ranking.Results: Based on available evidence, we classified the risk factors associated with recurrence to patients', radiological, and surgical factors. Patient factors include history of seizures, trauma, alcoholism, brain atrophy, and presence of CSF shunts, while the role of diabetes in relation to the recurrence is controversial. Radiologically the presence of air in the subdural space post-operatively, the width of the haematoma, and the presence of bilateral CSDHs are associated with increased risk of recurrence. While the predictive value of multiple membranes in the CSDH remains controversial. Surgically, the risk of recurrence was noted to be higher in patients with parietal or occipital compared to those who had frontal burr hole drainage, also placing a subdural drain decreases the chance of recurrence and some evidence showed better outcomes for frontally placed drains. The role of anti-inflammatory agents (including steroids) remains an area of ongoing debate. Conclusions: Risk factors for CSDH can be divided into patients', radiological, and surgical factors. We encourage health care providers to minimize if not prevent potentially avoidable factors. Patients with increased risks for recurrence should be identified early by the treating team and when possible should be informed about their higher than usual risk of recurrence. Moreover this review highlights the general lack of a sufficiently powered class I evidence addressing this topic and that further research is required in this topic.

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“…Chronic SDH is frequently encountered in neurological practice with a documented incidence rate of 1-2 per 100,000 population per year in the early CT era [12,13]. However, according to newer studies, the incidence appears to be as high as 13.1 cases per 100,000 [14].…”

Section: Discussionmentioning

confidence: 99%

SDH with Bleeding Diathesis—a Management Protocol

et al. 2015

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Chronic subdural hematoma (SDH) is one of the leading causes of morbidity and mortality in elderly. Patients taking antiplatelets and/or anticoagulants have increased risk of bleeding during the perioperative period. Precise dose blood products and specific surgical technique have been effective in preventing hemorrhagic complications perioperatively. From Jan 2010 to Dec 2012, 25 patients who were on antiplatelets and/or oral anticoagulants underwent emergency surgery for chronic or acute on chronic SDH. Patients were divided into three groups: group I-patients on antiplatelets, group II-patients on oral anticoagulants, and group III-patients taking both. Of these, 21 patients underwent minicraniotomy with microsurgical membranectomy and 4 patients underwent burr hole craniostomy. Random donor platelet concentrate (RDPC) and fresh frozen plasma (FFP) were used depending on whether patient was on antiplatelets or oral anticoagulants. Results were evaluated on the basis of ease of intraoperative hemostasis, incidence of rebleeding in postoperative period, postoperative imaging, and reversal of neurological deficits. Group I, group II, and group III had 16, 4, and 5 patients, respectively. Group I received a mean of 7 units of RDPC. Group II received a mean of 4 units of FFP. Group III received a mean of 7 units of RDPC and 4 units FFPs. There was no problem with intraoperative hemostasis and no incidence of rebleeding. We suggest specific dose protocol for reversal of antiplatelet and anticoagulant effect and specific surgical procedure in preventing intraoperative bleeding and postoperative rebleeding in the above group of patients.

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Epidemiology of chronic subdural haematoma

Cited by 219 publications

References 3 publications

Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma

Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma

Chronic Subdural Haematoma: Systematic Review Highlighting Risk Factors for Recurrent Bleeds

SDH with Bleeding Diathesis—a Management Protocol

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