A Clinical Analysis in Risk Factors of Chronic Subdural Hematoma: Focusing on the Age

Yang-Won Sim; Kyung-Soo Min; Mou-Seop Lee; Young-Gyu Kim; Dong-Ho Kim

doi:10.13004/kjnt.2021.8.0.115

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A Clinical Analysis in Risk Factors of Chronic Subdural Hematoma: Focusing on the Age

Original Article

Korean J Nutr 2012;8(2):115-121.

Published online: 19 January 2012

DOI: https://doi.org/10.13004/kjnt.2021.8.0.115

A Clinical Analysis in Risk Factors of Chronic Subdural Hematoma: Focusing on the Age

Yang-Won Sim, MD, Kyung-Soo Min, MD, Mou-Seop Lee, MD, Young-Gyu Kim, MD, Dong-Ho Kim, MD

Department of Neurosurgery, Chungbuk National University College of Medicine, Cheongju, Korea

Address for correspondence: Dong-Ho Kim, MD Department of Neurosurgery, Chungbuk National University College of Medicine, 776 1sunhwan-ro, Heungdeok-gu, Cheongju 361-711, Korea Tel: +82-43-269-6380, Fax: +82-43-273-1614 E-mail: dhkim@chungbuk.ac.kr

Received 27 April 2012 Revised 8 September 2012 Accepted 27 April 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective:

The current understanding reveals that chronic subdural hematoma (CSDH) is mostly the results of direct or indirect head trauma. Other factors such as alcoholism, medication (such as anticoagulants or antiplatelet agents), liver cirrhosis, chronic renal failure and hematologic disease are also well known as causes of CSDH. Of them, the authors attempted to identify the risk factors of CSDH by focusing on the age with a view point of recent increase in the elderly population.

Methods:

We retrospectively reviewed 216 consecutive CSDH patients who underwent surgery at our institute between 2002 and 2011. We classified them into two groups according to the patients’ age (Group A: ＜65 years old, Group B: ≥65 years old). Various factors were investigated for risk factor of CSDH, such as head trauma, chronic alcoholism, epilepsy, previous shunt surgery, underlying disease having bleeding tendency or medication affecting blood coagulation. And these factors were compared between the two groups for statistical significance.

Results:

Among the 216 patients, group A included 81 patients (37.5%), group B included 135 patients (62.5%). The medication of group B had significantly more proportion than group A, comparing to the result that group B had relatively less proportion of head trauma and alcoholism (p＜0.05). And medication was more associated with non-traumatic CSDH, especially in group B.

Conclusion:

As previously reported, head trauma or alcoholism are also most important causes as a risk factor of CSDH of all ages in our study. But medication is more closely related to the incidence of CSDH in group A, than group B.

Keywords: Chronic subdural hematoma, Risk factor, Age, Platelet aggregation inhibitor, Anticoagulants

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FIGURE 1.

The risk factors of CSDH in 216 patients subdivided according to age and percentage of patients with each risk factor. CSDH: chronic subdural hematoma.

FIGURE 2.

The percentage of medication as risk factor of CS-DH subdivided according to age and head trauma history. CSDH: chronic subdural hematoma.

TABLE 1.

Markwalder's neurologic grading system (Marwalder¹⁹⁾)

Grade	State of patient
Grade 0	Patient neurologically normal
Grade 1	Patient alert and oriented; such as headache; absent or mild symptoms or neurologic deficit; such as reflex asymmetry
Grade 2	Patient drowsy or disoriented with variable neurological deficit; such as hemiparesis
Grade 3	Patient stuporous but responding appropriately to noxious stimuli; severe focal signs; such as hemiplegia
Grade 4	Patient comatous with absent motor response to painful stimuli; decerebrate or decorticate posturing

TABLE 2.

Characteristics and clinical findings of 216 patients with CSDH

Group	Group A (n=81)	Group B (n=135) No. of patients (%)	Total (n=216)	p-value
Charateristic
Age (yrs)∗	49.0±10.7	73.7±5.3	64.3±11.8	-
Sex
Male	61 (75.3)	80 (59.3)	141 (65.3)	0.016
Female	20 (24.7)	55 (40.7)	75 (34.7)
Neurologic grade∗ (at admission)	1.7±0.6	1.9±0.5	1.8±0.6	0.030
Method of operation
Burr hole trephination	80 (98.8)	132 (97.8)	212 (98.2)	0.602
Craniotomy	1 (0.2)	3 (2.2)	4 (1.8)
Bilaterality	7 (8.6)	16 (11.9)	23 (10.7)	0.355
Recurrence	4 (4.9)	8 (5.9)	12 (5.5)	0.759
Mortality	0 (0.0)	2 (1.5)	2 (0.1)	-

Statistical analysis was performed with chi-square test. ∗Mean±SD. CSDH: chronic subdural hematoma, SD: standard deviation

TABLE 3.

Risk factors of CSDH in 216 patients

Group	Group A (n=81)	Group B (n=135) No. of patients (%)	Total (n=216)	p-value
Risk factors
Head trauma	56 (69.1)	80 (59.3)	136 (55.3)	0.190
Chronic alcoholism	17 (21.0)	22 (16.3)	39 (18.1)	0.465
Medication∗	5 (6.2)	18 (13.3)	23 (10.6)	0.045
Previous shunt surgery	2 (2.5)	3 (2.2)	5 (2.3)	0.848
Epilepsy	0 (0.0)	1 (0.7)	1 (0.4)	-
Coagulopathy^†	4 (4.9)	5 (3.7)	9 (4.2)	0.731
Unknown^‡	12 (14.8)	22 (16.3)	34 (15.7)	0.848

Statistical analysis was performed with Fisher's exact test. ∗antiplatelet agents (including aspirin, clopidogrel, or trifulsal) or anticoagulants (warfarin),

^† medical condition having bleeding tendency such as liver cirrhosis, chronic renal failure, receiving chemotherapy, or hematologic disorders,

^‡ having no clinical history that could be a cause of CSDH. CSDH: chronic subdural hematoma

TABLE 4.

Cause of CSDH in Group A and B with head trauma history

Trauma (+)	In group A (n=56)	In group B (n=80)	p-value
Trauma (+)	No. of patients (%)		p-value
Risk factors
Chronic alcoholism	11 (19.6)	9 (11.3)	0.220
Medication∗	3 (5.4)	6 (7.5)	0.736
Previous shunt surgery	1 (1.8)	0 (0.0)	-
Epilepsy	0 (0.0)	1 (1.3)	-
Coagulopathy^†	1 (1.8)	2 (2.5)	1.000

TABLE 5.

Cause of CSDH in Group A and B without head trauma history

Trauma (-)	In group A (n=25)	In group B (n=55)	p-value
Trauma (-)	No. of patients (%)		p-value
Risk factors
Chronic alcoholism	6 (24.0)	13(23.6)	1.000
Medication∗	2 (8.0)	12(21.8)	0.205
Previous shunt surgery	1 (4.0)	3 (5.5)	0.627
Epilepsy	0 (0.0)	0 (0.0)	-
Coagulopathy^†	3 (12.0)	3 (5.5)	0.370

Statistical analysis was performed with Fisher's exact test. ∗antiplatelet agents (including aspirin, clopidogrel, or trifulsal) or anticoagulants (warfarin),

^† medical condition having bleeding tendency such as liver cirrhosis, chronic renal failure, receiving chemotherapy, or hematologic disorders. CSDH: chronic subdural hematoma

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