[Chronic subdural hematoma occurring in patients with senile dementia: report of 4 cases]

Four cases are presented of male patients over 63 years of age. Preceding head injuries relating to chronic subdural hematoma (CSH) were noted in 2 patients. Suspected clinical signs of CSH were disturbance of consciousness and mono- or hemiparesis. Surgery, a burr-hole technique for external drainage, was performed in 2 patients, and nonsurgical treatment by intravenous administration of glycerol was carried out in the remaining 2 patients. After the treatment, 3 patients returned to the previous demented state, and one who had been treated nonsurgically died of pneumonia. Disappearance or marked reduction of the hematoma was demonstrated by follow-up CT scans in all patients. The signs induced by CSH in a patient with senile dementia may be misunderstood as an aggravation of senile dementia. Nonsurgical treatment with osmotic perfusions for CSH may be considered as a treatment of first choice in a patient with advanced senile dementia, unless he shows advanced mass effect of the hematoma on CT.