PDF
ePub
Citation
Print
Abstract
Objective
Incidence of chronic subdural hematoma (CSDH) is gradually increasing in young adults for several reasons. In this study, we aimed to identify features of CSDH noted in young adults that distinguish the disease from CSDH diagnosed in the elderly.
Methods
One hundred eighty-two patients with CSDH who underwent a total of 218 surgical procedures between January 2003 and February 2010 were retrospectively reviewed with regard to clinical presentation, radiographic results and prognosis including recurrence. To compare younger patients with the elderly, patients were divided into three groups on the basis of age (Group A: ≤40, Group B: 41–64, Group C: ≥65 years).
Results
Group A showed a male predominance (p=0.0001), lower rate of recurrence (p=0.0012), shorter symptom duration (p=0.035), and fewer leading signs such as hemispheric symptoms (p=0.005) compared to Groups B and C. Radiologic findings such as maximal hematoma thickness (p＜0.0001) and degree of midline shift (p=0.028) were less severe in Group A than Groups B and C. Alcoholism was the most prevalent illness in all three groups. When exempting infants with hematologic malignancy, non-recurrence, previous trauma history, headache as leading symptom, and no mortality were all common in younger adults (all p＜0.05).
Conclusion
Young adults with CSDH show less severe clinical and radiologic features as well as fewer recurrences than noted in the elderly population. Even if a clinician's index of suspicion of CSDH in young adults complaining of headache is not high, meticulous radiologic surveillance could find CSDH, leading to satisfactory results including less frequent recurrence.
References
1. Demirakca T, Ende G, Kämmerer N, Welzel-Marquez H, Hermann D, Heinz A, et al. Effects of alcoholism and continued abstinence on brain volumes in both genders. Alcohol Clin Exp Res. 35:1678–1685. 2011.
2. Ernestus RI, Beldzinski P, Lanfermann H, Klug N. Chronic subdural hematoma: surgical treatment and outcome in 104 patients. Surg Neurol. 48:220–225. 1997.
3. Fogelholm R, Heiskanen O, Waltimo O. Chronic subdural hematoma in adults. Influence of patient's age on symptoms, signs, and thickness of hematoma. J Neurosurg. 42:43–46. 1975.
4. Fogelholm R, Waltimo O. Epidemiology of chronic subdural haematoma. Acta Neurochir (Wien). 32:247–250. 1975.
5. Karibe H, Kameyama M, Kawase M, Hirano T, Kawaguchi T, Tominaga T. [Epidemiology of chronic subdural hematomas]. No Shinkei Geka. 39:1149–1153. 2011.
6. Lee KS, Bae WK, Doh JW, Bae HG, Yun IG. Origin of chronic subdural haematoma and relation to traumatic subdural lesions. Brain Inj. 12:901–910. 1998.
7. Liliang PC, Tsai YD, Liang CL, Lee TC, Chen HJ. Chronic subdural haematoma in young and extremely aged adults: a comparative study of two age groups. Injury. 33:345–348. 2002.
8. Markwalder TM. Chronic subdural hematomas: a review. J Neurosurg. 54:637–645. 1981.
9. Nayil K, Ramzan A, Sajad A, Zahoor S, Wani A, Nizami F, et al. Subdural hematomas: an analysis of 1181 Kashmiri patients. World Neurosurg. 77:103–110. 2012.
10. Paul CA, Au R, Fredman L, Massaro JM, Seshadri S, Decarli C, et al. Association of alcohol consumption with brain volume in the Framingham study. Arch Neurol. 65:1363–1367. 2008.
11. Robinson RG. Chronic subdural hematoma: surgical management in 133 patients. J Neurosurg. 61:263–268. 1984.
12. Sambasivan M. An overview of chronic subdural hematoma: experience with 2300 cases. Surg Neurol. 47:418–422. 1997.
13. Spallone A, Giuffrè R, Gagliardi FM, Vagnozzi R. Chronic subdural hematoma in extremely aged patients. Eur Neurol. 29:18–22. 1989.
14. Stanisic M, Lund-Johansen M, Mahesparan R. Treatment of chronic subdural hematoma by burrhole craniostomy in adults: influence of some factors on postoperative recurrence. Acta Neurochir (Wien). 147:1249–1256. ;discussion 1256–1257,. 2005.
15. Yamazaki Y, Tachibana S, Kitahara Y, Ohwada T. [Promotive factors of chronic subdural hematoma in relation to age]. No Shinkei Geka. 24:47–51. 1996.
TABLE 1.
Comparison of clinical presentations and radiologic findings in patients with chronic subdural hematoma according to age
| Age | .40 (A) | 41–64 (B) | .65 (C) | Total | p-value (A vs. B+C)∗ | p-value (A vs. B vs. C)∗∗ |
|---|---|---|---|---|---|---|
| Total patients | 15 | 66 | 101 | 182 | ||
| Female sex (%) | 1 (6.7%) | 15 (22.7%) | 18 (17.8%) | 34 (18.a7%) | 0.0001 | 0.0038 |
| Recurrence (%) | 1 (6.7%) | 11 (16.7%) | 19 (18.8%) | 31 (17%) | 0.0012 | 0.0012 |
| Symptom onset (day) | 20.5±4.6 | 28.2±7.7 | 30.4±6.8 | 28.8±8.3 | 0.035 | 0.055 |
| Trauma history (%) | 13 (87%) | 62 (94%) | 90 (89.1%) | 165 (91.7%) | 0.863 | 0.652 |
| Maximal thickness (cm) | 1.4±0.3 (0.9–3.3) | 3.2±1.1 (1.8–4.8) | 3.6±0.5 (2.0–5.4) | 3.3±1.8 (0.9–5.4) | <0.0001 | 0.0025 |
| Midline shift (mm) | 8.3±2.9 (5.3–14.2) | 10.5±4.1 (7.2–17.5) | 12.4±3.5 (6.8–18.5) | 11.4±4.8 (5.3–18.5) | 0.028 | 0.042 |
| Density (CT) low/high (iso)/mixed | 4/8/2003 | 22–29–15 | 34–49–18 | 60–86–36 | 0.35 | 0.284 |
| Leading symptom (n) | Headache (12) | Headache (38) | Headache (73) | 123 (67.6%) | 0.265 | 0.371 |
| Hemispheric Sx. (1) | Hemispheric Sx. (8) | Hemispheric Sx. (19) | 28 (15.4%) | 0.005 | 0.017 | |
| Vomiting (2) | Nausea/Vomiting (15) | Seizure (2) | ||||
| Premorbid disease (n) | Alcoholism (5) | Alcoholism (18) | Alcoholism (49) | 72 (39.6%) | 0.628 | 0.836 |
| Liver Dz. (4) | Liver Dz. (13) | Liver Dz. (16) | 33 (18.1%) | |||
| Hematologic Dz. (3) | Hematologic Dz. (4) | Hematologic Dz. (4) | ||||
| Medication (1) | Medication (8) | Medication (12) | ||||
| VP shunt (2) | VP shunt (2) | VP shunt (3) | ||||
| Death | Leukemia (1) | Aspiration pneumonia (1) | Cerebral infarct (1)Acute SDH (1) | 4 (2.1%) | 0.92 | 0.583 |
TABLE 2.
Comparison of clinical features of chronic subdural hematoma patients, excluding four patients younger than 10 and with hematologic malignancy
| Age | .40 (A) | 41–64 (B) | .65 (C) | Total | p-value(A vs. B+C)∗ | p-value(A vs. B vs. C)∗∗ |
|---|---|---|---|---|---|---|
| Total patients | 11 | 66 | 101 | 178 | ||
| Female sex (%) | 0 (0%) | 15 (22.7%) | 18 (17.8%) | 33 (18.5%) | 0 | 0 |
| Recurrence (%) | 0 (0%) | 11 (16.7%) | 19 (18.8%) | 30 (16.9%) | 0 | 0 |
| Symptom onset (day) | 18.9±3.3 | 28.2±7.7 | 30.4±6.8 | 28.5±4.1 | 0.002 | 0.041 |
| Trauma history (%) | 11 (100%) | 62 (94%) | 90 (89.1%) | 163 (91.6%) | 0 | 0 |
| Maximal thickness (cm) | 1.5±0.8 (1.1–3.3) | 3.2±1.1 (1.8–4.8) | 3.6±0.5 (2.0–5.4) | 3.3±5.8 | 0.0001 | 0.0001 |
| Midline shift (mm) | 8.1±0.9 (6.2–14.2) | 10.5±4.1 (7.2–17.5) | 12.4±3.5 (6.8–18.5) | 11.4±2.5 | 0.001 | 0.015 |
| Density (CT) low/high (iso)/mixed | 4/6/2001 | 22–29–15 | 34–49–18 | 60–84–34 | 0.481 | 0.347 |
| Leading symptom (n) | Headache (11) | Headache (38) | Headache (73) | 122 (68.5%) | 0.257 | 0.382 |
| Hemispheric Sx. (0) | Hemispheric Sx. (8) | Hemispheric Sx. (19) | 27 (15.2%) | 0 | 0 | |
| Nausea/Vomiting (15) | Seizure (2) | |||||
| Premorbid disease (n) | Alcoholism (5) | Alcoholism (18) | Alcoholism (49) | 72 (40.4%) | 0.571 | 0.803 |
| Liver disease (2) | Liver disease (13) | Liver disease (16) | 31 (17.4%) | 0.351 | 0.829 | |
| Drug (1) | Hematologic Dz. (4) | Hematologic Dz. (4) | ||||
| VP shunt (1) | Drug (8) | Drug (12) | ||||
| VP shunt (2) | VP shunt (3) | |||||
| Death | 0 | Aspiration pneumonia (1) | Cerebral infarct (1)Acute SDH (1) | 3 (1.7%) | 0 | 0 |
XML Download