Interhemispheric and bilateral chronic subdural hematoma

Data on bilateral chronic subdural hematomas (CSHs) are scant, including information on the frequency of symptoms, response to various treatments, and postoperative complications, compared with data on unilateral CSH. Bilateral CSHs constitute a fair portion of CSHs, especially in patients older than 75 years and in those with coagulation abnormalities. The presenting symptoms are those of increased intracranial pressure and mass effect. Computed tomography of the head is the best study for the diagnosis and follow-up of bilateral CSHs, although magnetic resonance imaging is a more sensitive modality. Treatment of bilateral CSHs presents its own unique set of problems. New hemorrhage on the contralateral side and shift of midline structures are concerns and can be avoided by simultaneous bilateral decompression. Twist-drill craniostomy, burr-hole washout, and craniotomy are the mainstays of treatment, with subdural-peritoneal shunting reserved for intractable cases.

Causes, epidemiology, and risk factors of chronic subdural hematoma

Chronic subdural hematoma is an important reversible cause of dementia and disability in the elderly. A sufficiently high level of clinical suspicion and prompt radiographic evaluation may allow for timely treatment to avoid poor outcomes. Thankfully, the routine use of computed tomographic scanning in most emergency facilities has made the diagnosis of these lesions commonplace.

Spinal chronic subdural hematoma

Although chronic subdural hematomas are rare, they are likely to be more frequently reported as the clinical and magnetic resonance imaging characteristics become defined. Chronic spinal subdural hematomas (CSSDH) are extremely rare; these hematomas are frequently spontaneous and related to minor trauma. Although generally said to carry a poor prognosis, CSSDH can be a reversible cause of paraplegia. This article reviews the history, classification, clinical presentation, and treatment of CSSDH.

Percutaneous subdural tapping and subdural peritoneal drainage for the treatment of subdural hematoma

Different therapeutic approaches may be used in the treatment of chronic subdural hematoma because it is more fluid. Age-dependent characteristics of the calvarium allow for different treatment in children and adults. Treatment options are discussed.

A prospective study of chronic subdural haematomas in elderly patients

OBJECTIVE

to study clinical features and prognosis of older people with chronic subdural haematoma who present to an elderly medicine department rather than a neurosurgical unit.

DESIGN

prospective descriptive study with immediate and 6-month follow-up.

SUBJECTS

patients aged 75 and over with chronic subdural haematoma presenting to an elderly medicine service, selected on the basis of age alone.

METHODS

information was taken from inpatient notes and computerized tomographs and, for 6-month follow-up, from outpatient clinics, inpatient notes or via the general practitioner.

RESULTS

the most common presenting features were falls and progressive neurological deficit. 42% of patients were known to be confused before their chronic subdural haematoma. Only 37% of the patients were treated by neurosurgeons. The others were managed conservatively either because they were unfit for surgery or the haematoma was small. There was only one death related to surgery but 31% of patients died within 6 months of diagnosis.

CONCLUSION

Elderly patients in neurosurgical series are a selected subgroup of older patients with subdural haematoma.

[Encephalic morphologic changes due to delayed traumatic intracerebral hematoma]

Pathological changes of brain tissues due to delayed traumatic intracerebral hematoma (DTICH) in 6 cases were studied and the mechanism was discussed. It was observed that DTICH went with old brain contusion, traumatic angionecrosis, vasculitis, calcification, encapsulated old focus, proliferation and reactive hypertrophy in glia. Brain contusions and traumatic vessel lesions are important pathological foundations of cerebral hemorrhage and primary causes of DTICH.