Aphasia and Chronic Subdural Hematoma Evacuation: A Retrospective Cohort Study

The incidence of subdural hematomas (SDH) is expected to climb precipitously in the coming decades. Aphasia is one of the most common operative neurological symptoms of left-sided SDH. However, the rates of aphasia recovery after SDH evacuation have not been reported as neurological outcomes have been limited to mostly functional assessment scores and mortality. This study represents the first detailed analysis on aphasia and recovery in patients undergoing chronic SDH (cSDH) evacuation.

Adult patients who underwent evacuation of subacute or cSDH at a tertiary academic medical center between November 2013 and December 2021 were retrospectively identified using ICD 9 and 10 billing codes. Patients were categorized by the presence or absence of aphasia at initial presentation. Other clinical and demographic variables were also collected. After surgical evacuation, improvement and resolution of aphasia was recorded at the time of discharge, along with several outcome metrics.

Of the 311 patients requiring cSDH evacuation who met inclusion criteria, 10% presented with aphasia. Risk factors for the development of aphasia were evaluated, including age, sex, hypertension, SDH size, location laterality, and midline shift size. Only left-sided SDH laterality was associated with a significantly greater risk of aphasia compared with right-sided and bilateral SDH (odds ratio 4.89, P < .001) while adjusting for age and sex. No difference in the rate of postoperative complications, neurological outcome, or mortality was found between patient cohorts. After surgical evacuation, 90% of patients had improvement of aphasia by the time of discharge, and 73% had complete resolution. At most recent follow-up (<180 days), aphasia had resolved in 83% of patients.

This study represents one of the first detailed investigations into patients presenting with aphasia in the setting of cSDH. These findings provide unique insights to aid in management and rehabilitation planning of patients with cSDH presenting with aphasia.