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[Chronic subdural hematoma: a disease of elderly people]
Patricio Tagle1, Francisco Mery, Gonzalo Torrealba
1Departamento de Neurocirugía y Departamento de Neurología, Facultad de Medicina, Pontificia Universidad Católica de Chile. ptagle@med.puc.cl
Insights
Chronic subdural hematoma (CSH) diagnosis can be challenging. Burr hole drainage offers a good outcome for most CSH patients, with high recovery rates and low surgical mortality.
Area of Science:
- Neurosurgery
- Neurology
- Medical Diagnostics
Context:
- Chronic subdural hematoma (CSH) presents with non-specific symptoms, complicating diagnosis.
- CSH diagnosis is often delayed due to its heterogeneous clinical presentation.
- Neurosurgical intervention is crucial for managing CSH.
Purpose:
- To detail the clinical experience with chronic subdural hematoma at a neurosurgical service.
- To analyze the diagnostic challenges and treatment outcomes for CSH patients.
- To identify prognostic factors influencing CSH patient recovery.
Summary:
- A study analyzed 100 patients (mean age 77 years) with CSH, primarily presenting with mental status changes (50%) or focal neurological deficits (46%).
- All patients underwent burr hole drainage; 13% experienced recurrence and required reoperation. Surgical mortality was 3%.
- Long-term follow-up (mean 66 months) showed 81% complete recovery, 6% permanent deficits, and 2% dependency. Absence of trauma history and dementia symptoms predicted poor prognosis.
Impact:
- Burr hole drainage is an effective treatment for chronic subdural hematoma, leading to favorable outcomes in the majority of cases.
- Understanding prognostic indicators like dementia symptoms and trauma history can guide clinical management and patient counseling.
- This experience highlights the importance of timely diagnosis and surgical intervention for improving CSH patient prognosis.
Background:
The lack of specificity and heterogeneity of the clinical picture of chronic subdural hematoma, hampers its diagnosis.
Aim:
To report the experience of a Neurosurgical Service in chronic subdural hematoma.
Patients And Methods:
One hundred patients (77 male, mean age 77 +/- 13 years) with chronic subdural hematoma were analyzed.
Results:
The main clinical presentations were mental status changes (50%) and progressive focal neurological deficit (46%). Five cases presented as a transient neurological deficit. All patients were treated with burr hole drainage. Thirteen had recurrence of the hematoma and they were reoperated. The surgical mortality was 3%. Eighty seven patients were followed for a mean of 66 months. Eighty one of these had a complete recovery, 6 had permanent neurological deficit and 2 of these were unable to care for themselves. Bad prognosis was associated with the absence of a previous trauma to explain the hematoma and symptoms of dementia as the clinical presentation.
Conclusions:
Most patients with chronic subdural hematoma treated with burr hole drainage have a good outcome.