Spontaneous chronic subdural hematoma in elderly people – Arterial hypertension and other risk factors

Kostić, Aleksandar; Kehayov, Ivo; Stojanović, Nebojša; Nikolov, Vesna; Kitov, Borislav; Milošević, Predrag; Kostić, E.; Zhelyazkov, Hristo

doi:10.1016/j.jcma.2018.03.010

Cited by 15 publications

(7 citation statements)

References 43 publications

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“…Dakurah et al had 9.7% in Accra, Bankole et al had 22.9% in Lagos, Jimoh et al had 23.3% in Zaria and Chikani et al had 15.87% in Enugu [ 16 , 17 , 20 – 23 ]. The higher percentage of hypertensives found in this study is however consistent with a recent multi-centre report from Eastern Europe which indicated that as high as 75% of patients with CSDH were hypertensives [ 24 ]. It has been suggested that hypertension predisposes to spontaneous intracranial bleeds and this could be responsible for its high prevalence in patients with CSDH.…”

Section: Discussionsupporting

confidence: 92%

Predictors of recurrence of chronic subdural haematoma in a cohort study of patients presenting in a sub-Saharan African teaching hospital

et al. 2022

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Background Chronic subdural haematoma (CSDH) is a common neurological condition affecting the elderly with decreased quality of life. Recurrence leads to increase in number of hospital admissions and surgical interventions. Several factors contribute to recurrence of chronic subdural haematoma, and determination of these factors will help institute measures to reduce recurrence of CSDH, cost of care and improved quality of life. The aim of this study was to determine the predictors of recurrence of chronic subdural haematoma in a cohort of patients presenting in a Sub-Saharan African Teaching Hospital. Methods A prospective hospital-based cohort study of 62 participants who presented with CSDH and underwent burr-hole and drainage at the Neuroscience unit of the Korle-bu Teaching Hospital. The primary outcome of this study was the recurrence of CSDH within 3 months after the surgery. Data was entered into Microsoft Excel 2016 and exported to International Business Machine (IBM) Statistical Package for the Social Sciences (SPSS) version 21.0 for analysis. Predictors of recurrence of CSDH were determined using logistic regression with odds ratio calculated at the 95% confidence level and a p-value less than 0.05 accepted as statistically significant. Results There was a male preponderance of 45 (72.6%), over females of 17 (27.4%). The mean age was 63.1 ± 13.6 years. The recurrence rate of CSDH was 21.0% whilst the mortality rate was 4.8%. Facial palsy and dysphasia were associated with the recurrence of CSDH (p = 0.045, 0.029). Hypertension and bilaterality were associated with recurrence of CSDH from a univariate analysis (p = 0.039, OR = 4.865, CI = 0.975–24.285; p = 0.005, OR = 5.979, CI = 1.585–22.557). In a multivariate logistic regression analysis, bilaterality was the only independent predictor of recurrence of CSDH (p = 0.030, AOR = 5.47, CI = 1.18–25.34). Conclusions Both hypertension and bilaterality showed statistically significant association with recurrence of CSDH. However, only bilaterality proved to be an independent predictor of recurrence of CSDH in patient who underwent burr-hole and drainage.

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Section: Discussionsupporting

confidence: 92%

Predictors of recurrence of chronic subdural haematoma in a cohort study of patients presenting in a sub-Saharan African teaching hospital

et al. 2022

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“…[1,4,6] Spontaneous SDH in the middle age group usually occurs unilaterally with one or more of the predisposing factors mentioned above. [7,12] In the nongeriatric age group, extensive investigations should be conducted before labeling the case as a spontaneous idiopathic SDH. A study that performed a literature review on spontaneous SDH case reports found only 22 cases of patients <40-years-old, and all the cases had unilateral SDH.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic spontaneous bilateral subdural hematoma in a 28-year-old male: A comprehensive literature review and case report

Algahtani

Alghamdi

Ashqar

et al. 2023

Surgical Neurology International

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Background: Subdural hematoma (SDH) is considered spontaneous in the absence of trauma history. It is a common presentation in the geriatric age group due to the many influential factors. Most cases have a known underlying etiology that explains the incidence, otherwise, they are considered idiopathic. We present a rare case report of idiopathic nontraumatic bilateral SDH with a literature review of similar cases. Case Description: A 28-year-old fit individual presented to the Emergency Department with a chronic history of severe headache and neck pain, associated with behavioral changes in the last 2 days. He reported that his symptoms started after lifting a heavy object 2 months ago; however, they became worse after a neck chiropractor therapy session. He is not on any chronic medications, and there was a negative history of trauma, seizure, hematological diseases, family history of neurological conditions, smoking, alcohol, or drug abuse with an unremarkable systemic review. A brain computerized tomography (CT) showed bilateral SDHs, for which he underwent bilateral mini craniotomies and drainage. The symptoms improved after surgery and the follow-up brain CT showed no recurrence. Conclusion: Idiopathic spontaneous bilateral SDH in the adult age group is an extremely rare pathology and the literature review only revealed three similar cases. With the absence of any pathology that would explain the presentation after extensive investigations, we hypothesized that a sudden rise in vascular pressure was the underlying etiology, especially with the fact that the symptoms became unbearable after the neck chiropractor therapy session.

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“…The median age was 75 years, and 71% of the patients were male. Reports show that brain atrophy progresses with age, and the incidence of spontaneous CSDH related to age is significant [ 24 , 26 ]. The high proportion of male patients may be the result of having differences in cranium anatomy, such as size and asymmetry, and activity compared to females [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…It is difficult to find published studies demonstrating a significant association between alcoholism and CSDH recurrence. Kostić et al [ 24 ] reported risk factors for spontaneous CSDH in elderly patients and showed that the percentage of heavy drinkers in the CSDH group was significantly higher than that in the control group. Chen et al [ 9 ] reported that patients with liver cirrhosis and CSDH are significantly more likely to have serious comorbidities, including mortality rate.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Current Managements for Patients with Chronic Subdural Hematoma : A Retrospective Multicenter Pilot Study in the Republic of Korea

Oh¹,

Seo²,

Choo

et al. 2022

J Korean Neurosurg Soc

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Objective : Chronic subdural hematoma (CSDH) is a common disease in neurosurgical departments, but optimal perioperative management guidelines have not yet been established. We aimed to assess the current clinical management and outcomes for CSDH patients and identify prognostic factors for CSDH recurrence.Methods : We enrolled a total of 293 consecutive patients with CSDH who underwent burr hole craniostomy at seven institutions in 2018. Clinical and surgery-related characteristics and surgical outcomes were analyzed. The cohort included 208 men and 85 women.Results : The median patient age was 75 years. Antithrombotic agents were prescribed to 105 patients. History of head trauma was identified in 59% of patients. Two hundred twenty-seven of 293 patients (77.5%) had unilateral hematoma and 46.1% had a homogenous hematoma type. About 70% of patients underwent surgery under general anesthesia, and 74.7% underwent a single burr hole craniostomy surgery. Recurrence requiring surgery was observed in 17 of 293 patients (5.8%), with a median of 32 days to recurrence. The postoperative complication rate was 4.1%. In multivariate analysis, factors associated with CSDH recurrence were separated hematoma type (odds ratio, 3.906; p=0.017) and patient who underwent surgery under general anesthesia had less recurrence (odds ratio, 0.277; p=0.017).Conclusion : This is the first retrospective multicenter generalized cohort pilot study in the Republic of Korea as a first step towards the development of Korean clinical practice guidelines for CSDH. The type of hematoma and anesthesia was associated with CSDH recurrence. Although the detailed surgical method differs depending on the institution, the surgical treatment of CSDH was effective. Further studies may establish appropriate management guidelines to minimize CSDH recurrence.

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Spontaneous chronic subdural hematoma in elderly people – Arterial hypertension and other risk factors

Cited by 15 publications

References 43 publications

Predictors of recurrence of chronic subdural haematoma in a cohort study of patients presenting in a sub-Saharan African teaching hospital

Predictors of recurrence of chronic subdural haematoma in a cohort study of patients presenting in a sub-Saharan African teaching hospital

Idiopathic spontaneous bilateral subdural hematoma in a 28-year-old male: A comprehensive literature review and case report

Clinical Characteristics and Current Managements for Patients with Chronic Subdural Hematoma : A Retrospective Multicenter Pilot Study in the Republic of Korea

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