Clinical Course in Chronic Subdural Hematoma Patients Aged 18-49 Compared to Patients 50 Years and Above: A...

Area of Science:

• Neurosurgery
• Geriatric Medicine
• Neurology

Background:

• Chronic Subdural Hematoma (cSDH) is more prevalent in the elderly, with rarity in individuals under 50.
• Age-related brain atrophy may influence cSDH clinical presentation and patient outcomes.
• Understanding age-specific cSDH presentations is crucial for timely diagnosis and management.

Purpose of the Study:

• To investigate the clinical course and presentation of cSDH in younger patients (<50 years).
• To compare clinical presentations, morbidity, recurrence, and mortality between younger and older cSDH patient cohorts.
• To conduct a meta-analysis to validate age-related differences in cSDH clinical patterns.

Main Methods:

• Retrospective review of 1,252 surgically treated cSDH patients from Scandinavian neurosurgical centers.
• Primary endpoint: Differences in clinical presentation between patients <50 years and ≥50 years.
• Secondary endpoints: Comparison of perioperative morbidity, recurrence, and 90-day mortality between age groups; meta-analysis of clinical patterns.

Main Results:

• Younger patients (<50 years) were more likely to present with headache (86.5%) and vomiting (25%) compared to older patients (≥50 years).
• Older patients (≥50 years) more frequently exhibited limb weakness (44.8%), speech impairment (26.2%), and gait disturbance/falls (50.7%).
• No significant differences were observed in recurrence rates, overall complication rates, or 90-day mortality between the age groups. Meta-analysis confirmed headache as a primary symptom in younger patients and hemispheric symptoms in older patients.

Conclusions:

• Younger cSDH patients typically present with symptoms indicative of increased intracranial pressure (e.g., headache, vomiting).
• Older cSDH patients more commonly present with focal hemispheric symptoms (e.g., weakness, speech impairment, gait disturbance).
• Despite differing clinical presentations, recurrence, morbidity, and short-term mortality rates are comparable across age groups, highlighting the importance of recognizing age-specific symptom variations for accurate diagnosis.