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Chronic subdural haematoma in the elderly--a North Wales experience
Muhammad Asghar1, Vedamurthy Adhiyaman, M W Greenway
1Gloucestershire Royal Hospital, Gloucester GN1 3NN, UK.
Insights
Chronic subdural hematoma (CSDH) in elderly patients is common, with falls and antithrombotic therapy as key risks. Surgical intervention improves outcomes, though frailty complicates recovery.
Area of Science:
- Geriatrics
- Neurosurgery
- Epidemiology
Background:
- Chronic subdural hematoma (CSDH) is a significant condition, particularly in the elderly population.
- Existing data on CSDH in older adults are often outdated, necessitating current research.
Purpose of the Study:
- To investigate the incidence, risk factors, clinical presentation, management, and outcomes of CSDH in patients over 65 years.
- To provide updated epidemiological and clinical insights into CSDH in the elderly.
Main Methods:
- Retrospective study of 40 CSDH cases in patients >65 years from 1996-1999.
- Analysis of incidence, risk factors (falls, antithrombotic therapy), presenting symptoms (altered mental state, focal deficits), and treatment outcomes.
- Comparison of mortality rates between surgical and non-surgical management groups.
Main Results:
- Incidence of CSDH in the elderly population (>65 years) was 8.2/100,000.
- Frequent risk factors included falls (57%) and antithrombotic therapy (33%).
- Altered mental state (52%) and focal neurological deficit (50%) were common presentations. Surgical intervention in 60% of patients resulted in a 17% mortality rate, compared to 44% in the non-operated group.
Conclusions:
- CSDH is a prevalent condition in the elderly, with falls and antithrombotic use as major risk factors.
- Surgical management of CSDH in the elderly is associated with lower mortality rates.
- Frailty and comorbidities significantly contribute to mortality in elderly CSDH patients, even post-surgery.
Abstract:
Chronic subdural haematoma (CSDH) is predominantly a disease of the elderly. Most of the existing data come from studies done several decades ago. We examined the incidence, risk factors, clinical presentation, management and outcome in elderly patients with CSDH by retrospective study of the period 1996-1999 in the three district hospitals of North Wales. 40 cases of CSDH were identified in patients >65 years, the incidence in this population being 8.2/100,000. Falls (57%) and antithrombotic therapy (33%) were the most frequent risk factors. The most common presenting features were altered mental state (52%) and focal neurological deficit (50%). 24 patients (60%) underwent surgical intervention with 4 deaths (17%). In the non-operated group mortality was 7/16 (44%). Most of the deaths in this series were due either to CSDH or to the complications of frailty and poor mobility. Surgery itself was generally successful.