Trial of Dexamethasone for Chronic Subdural Hematoma

BACKGROUND

Chronic subdural hematoma is a common neurologic disorder that is especially prevalent among older people. The effect of dexamethasone on outcomes in patients with chronic subdural hematoma has not been well studied.

METHODS

We conducted a multicenter, randomized trial in the United Kingdom that enrolled adult patients with symptomatic chronic subdural hematoma. The patients were assigned in a 1:1 ratio to receive a 2-week tapering course of oral dexamethasone, starting at 8 mg twice daily, or placebo. The decision to surgically evacuate the hematoma was made by the treating clinician. The primary outcome was a score of 0 to 3, representing a favorable outcome, on the modified Rankin scale at 6 months after randomization; scores range from 0 (no symptoms) to 6 (death).

RESULTS

From August 2015 through November 2019, a total of 748 patients were included in the trial after randomization - 375 were assigned to the dexamethasone group and 373 to the placebo group. The mean age of the patients was 74 years, and 94% underwent surgery to evacuate their hematomas during the index admission; 60% in both groups had a score of 1 to 3 on the modified Rankin scale at admission. In a modified intention-to-treat analysis that excluded the patients who withdrew consent for participation in the trial or who were lost to follow-up, leaving a total of 680 patients, a favorable outcome was reported in 286 of 341 patients (83.9%) in the dexamethasone group and in 306 of 339 patients (90.3%) in the placebo group (difference, -6.4 percentage points [95% confidence interval, -11.4 to -1.4] in favor of the placebo group; P = 0.01). Among the patients with available data, repeat surgery for recurrence of the hematoma was performed in 6 of 349 patients (1.7%) in the dexamethasone group and in 25 of 350 patients (7.1%) in the placebo group. More adverse events occurred in the dexamethasone group than in the placebo group.

CONCLUSIONS

Among adults with symptomatic chronic subdural hematoma, most of whom had undergone surgery to remove their hematomas during the index admission, treatment with dexamethasone resulted in fewer favorable outcomes and more adverse events than placebo at 6 months, but fewer repeat operations were performed in the dexamethasone group. (Funded by the National Institute for Health Research Health Technology Assessment Programme; Dex-CSDH ISRCTN number, ISRCTN80782810.).

Statistical analysis plan for the Dex-CSDH trial: a randomised, double-blind, placebo-controlled trial of a 2-week course of dexamethasone for adult patients with a symptomatic chronic subdural haematoma

BACKGROUND

The incidence of chronic subdural haematoma (CSDH) is increasing. Although surgery remains the mainstay of management for symptomatic patients, uncertainty remains regarding the role of steroids. Hence, the Dex-CSDH trial was launched in the UK in 2015 aiming to determine whether, compared to placebo, dexamethasone can improve the 6-month functional outcome of patients with symptomatic CSDH by reducing the rate of surgical intervention and recurrence rate.

METHODS AND DESIGN

Dex-CSDH is a multi-centre, pragmatic, parallel group, double-blind, randomised trial assessing the clinical utility of a 2-week course of dexamethasone following a CSDH. Seven hundred fifty patients were randomised to either dexamethasone or placebo. The primary outcome is the modified Rankin Scale at 6 months which is dichotomised to favourable (a score of 0-3) versus unfavourable (a score of 4-6).

CONCLUSIONS

This paper and the accompanying additional material describe the statistical analysis plan for the trial.

TRIAL REGISTRATION

ISRCTN, ISRCTN80782810. Registered on 7 November 2014. http://www.isrctn.com/ISRCTN80782810. EudraCT, 2014-004948-35. Registered on 20 March 2015.

Treatment Outcomes of Burr-Hole Surgery for Chronic Subdural Hematoma in the Elderly Living Beyond Life Expectancy: A Study Comparing Cure, Recurrence, and Complications in Patients Aged ≥80 Years versus ≤79 Years

BACKGROUND

Few reports have focused on chronic subdural hematoma (CSDH) in the very elderly, who have lived beyond average life expectancy. Our aim is to appraise treatment outcomes of burr-hole craniotomy for CSDH in the elderly, focusing on cure, recurrence, and complications.

METHODS

Fifty patients ≤79 years of age (group A) and 73 patients ≥80 years of age (group B) were studied. Recurrence was defined as requiring reoperation for hematoma regrowth or symptomatic failure. A cure was regarded as having been achieved in the absence of hematoma on postoperative computed tomography. Complications were defined as any harmful event related to the treatment procedure for CSDH.

RESULTS

Cure was documented in 31 patients in group A (63%) and 24 patients in group B (33%) (P = 0.0017). Median intervals to cure were 2.76 and 3.73 months, respectively (P = 0.06). Cumulative cure rates were 51%/76% and 36%/59%, respectively, at the sixth/twelfth postoperative months. Recurrence was documented in 2 patients (4%) and 11 patients (15%), respectively (P = 0.07). Median intervals to recurrence were 0.81 and 1.25 months, respectively (P = 0.049). Cumulative recurrence-free rates were 96%/92% and 87%/75%, respectively, at the third/sixth postoperative months. Complications were observed in 2 patients (4%) and 4 patients (5%), respectively (P = 1.00).

CONCLUSIONS

With advancing age, CSDH might show a greater tendency to recur and a longer time is required to achieve a cure. However, complications developed only in high-risk patients. Thus, surgical treatment for CSDH in elderly patients, even those who have lived beyond life expectancy, might provide acceptably effective results.

The effects of antithrombotic drugs on the recurrence and mortality in patients with chronic subdural hematoma: A meta-analysis

OBJECTIVES

Chronic subdural hematoma (cSDH) is a common neurological disorder in elderly and the immediate outcome of surgery is satisfied. The high reoperation rate hinders the long-term effect of surgery and the risk factor is still unclear. Some researchers reported that high recurrence rate is related to the antithrombotic (AT) drugs, which is commonly used to prevent diseases in elderly patients. In this article, we conducted a meta-analysis to determine whether AT agents increase the risk of recurrence and mortality in patients with cSDH.

METHODS

The human case-control or randomized controlled trial (RCT) studies regarding the association of cSDH and AT were systematically identified through online databases (PubMed, Cochrane, Web of Science, Elsevier Science Direct, and Springer Link). Inclusion and exclusion criteria were defined for the eligible studies. The fixed-effects model was performed when homogeneity was indicated.

RESULTS

This meta-analysis included 24 studies. AT drugs significantly increased the risk of recurrence in patients with cSDH (odds ratio (OR) of 1.30, 95% confidence interval (CI), 1.11-1.52, P = .001). Further analysis demonstrated that both anticoagulation (OR of 1.41, 95% CI, 1.10-1.81, P = .006) and antiplatelet (OR of 1.23, 95% CI, 1.01-1.49, P = .03) had higher risk of recurrence, but no difference was found between them (OR of 0.80, 95% CI, 0.58-1.09, P = .16). However AT drugs did not increase the risk of mortality for patients with cSDH (OR of 1.08, 95% CI, 0.61-1.92, P = .78).

CONCLUSION

AT treatment is an important risk factor of recurrence in patients with cSDH in spite of similar mortality rate. When and how to resume AT drugs is still unclear, more well-designed prospective researches are needed on this issue.

CORE TIP

High recurrence is an important factor against the long-term outcome of surgery in patients with cSDH, the use of AT drugs is a potential risk factor. In this study we found that the use of AT drugs increased the risk of recurrence rather than mortality. Anticoagulation and antiplatelet showed no difference in causing cSDH recurrence.

Chronic subdural hematoma management: clarifying the definitions of outcome measures to better understand treatment efficacy - a systematic review and meta-analysis

OBJECTIVE

A long history of inconsistencies in the definitions of the outcome measures for chronic subdural hematomas (CSDHs) has contributed to the controversy over the optimal surgical strategy for CSDH treatment. Clarifying these definitions, reassess the available data, and systematically review the prior literature may provide better insight into the differences in treatment efficacy for CSDH.

MATERIALS AND METHODS

The clinical course of CSDH was described with a series of strictly defined outcome measures. PubMed, Cochrane Library, and ScienceDirect databases were searched for comparative studies of two main surgical techniques for CSDH, including burr hole craniotomy (BHC) and twist drill craniotomy (TDC). Data were collected with uniform criteria and analyzed using a random-effects model to estimate the mortality, recurrence, operative failure, and cure rates of each treatment.

RESULTS

Twelve comparative studies that examined 2,027 CSDH patients were included. The analysis results indicated that TDC and BHC treatments were similar in the mortality rates (RR, 1.25; 95% CI, 0.83-1.87; I2 = 0%; p = 0.28) and the recurrence rates (RR, 1.29; 95% CI, 0.87-1.92; I2 = 13%; p = 0.21) for CSDH patients. However, TDC had a significantly higher operative failure rate compared with BHC (RR, 0.35; 95% CI, 0.15-0.83; I2 = 0%; p = 0.02), whereas patients treated by a TDC approach tended to achieve higher cure rates compared with BHC (RR, 0.92; 95% CI, 0.86-0.99; I2 = 55%; p = 0.02).

CONCLUSIONS

The clarification of the definitions related to CSDH outcome facilitates the interpretation of differences in treatment efficacy. The TDC approach manifested a significantly higher operative failure rate compared with the BHC approach; however, TDC showed a tendency in achieving a long-term neurologic cure.

[Chronic subdural hematoma in the elderly]

Chronic subdural hematoma (cSDH) is a common condition, the frequency of which further increases due to an aging population and more frequent use of antithrombotic drugs. It leads to unspecific symptoms and neurological deficits and is usually treated surgically. Burr hole trepanation and twist drill craniostomy have become the therapeutic standards with craniotomy being rarely used for recurrent cases. Although recurrences are relatively common, in most cases a good outcome can be achieved even in the elderly; however, as cSDH is associated with other comorbidities, it is indicative of an increased morbidity and mortality. Controlled trials need to be carried out to determine whether pharmacological therapies can also be beneficial in addition to surgical treatment.

Chronic subdural haematoma in elderly patients: a retrospective analysis of 322 patients between the ages of 65-94 years

BACKGROUND

Chronic subdural haematoma (cSDH) is a common disease in neurosurgical practise, especially in elderly patients. This is of growing importance as the number of elderly people in the population is increasing steadily. There are scarce data focussing especially on elderly patients with cSDH. This study intended to evaluate the outcome and peri-operative risks in elderly patients with cSDH.

METHODS

We retrospectively reviewed medical records of 322 consecutive patients aged ≥65 years treated at our department between 2002 and 2009 focussing on outcome, aetiology, peri-operative risks, recurrence rate, and co-factors such as concomitant diseases and therapy with anticoagulants. The surgical procedure included burr-hole craniostomy followed by insertion of a subdural drain in each case. The outcome was classified according to the Karnofsky performance status (KPS) and modified Rankin Scale (mRS) score. Patients were divided into three groups according to age (group I: age 65-74 years, group II: 75-84 years, group III: 85-94 years).

RESULTS

Three hundred twenty-two patients underwent burr-hole craniostomy for cSDH in 399 surgical procedures. The mean age was 76 ± 7.9 years. After surgery, the mean neurological status improved in all three groups. Overall favourable outcome (mRS 0-2) was achieved in 83 % in group I, 68 % in group II and 51 % in group III, respectively. The rate of recurrence was lower in group III (7.5 %) compared to groups I (21.5 %) and II (27.37 %, p = 0.004). Overall, complication rates and peri-operative mortality (2.75 %) did not differ significantly between the age groups.

CONCLUSION

The data of the current study suggest that treatment of cSDH is safe in elderly patients. Patients aged above 85 years carry a greater risk for peri-operative complications, i.e. aSDH, and therefore have to be examined and monitored meticulously in order to prevent complications.

Changing trends in chronic subdural haematoma in Nigeria

OBJECTIVE

Chronic subdural haematoma (CSDH) is common in the elderly and is often associated with serious morbidity and mortality. Previous reports from Africa indicate earlier age of onset and a generally better tolerated condition compared with more developed countries. As the average age of the Nigerian population increases with associated medical problems, the pattern of the disease is expected to change towards that seen in more developed countries.

METHODS

The study is a retrospective review of 130 patients presenting to the Memfys hospital for Neurosurgery Enugu. The demographic, causal and clinical patterns were analysed. These were compared with previous studies from Africa. 116 patients who had surgical intervention were further analysed for management and outcome.

RESULTS

The male female ratio was 3:1 and the peak age incidence was in the 6th decade. 50.8% of cases resulted from road traffic accidents (RTA) and 21.5% from falls. Other causes included Neurosurgical procedure in 2.3%. The commonest presentations were headaches and altered consciousness. Nineteen patients were on antiplatelet drugs. Surgical treatment was with burr hole craniostomy and drainage in all cases with a perioperative mortality of 0.8%. Reoperation rate was 7.8% in all cases but 36% in patients on antiplatelet/anticoagulants. The outcome at six weeks using the Glasgow Outcome Scale (GOS) was good in 87%.

CONCLUSION

The pattern of CSDH in Nigeria has changed towards that seen in developed countries. There is also a general increase in frequency of the condition, and health care systems must be planned to meet this change.

Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial

BACKGROUND

Chronic subdural haematoma causes serious morbidity and mortality. It recurs after surgical evacuation in 5-30% of patients. Drains might reduce recurrence but are not used routinely. Our aim was to investigate the effect of drains on recurrence rates and clinical outcomes.

METHODS

We did a randomised controlled trial at one UK centre between November, 2004, and November, 2007. 269 patients aged 18 years and older with a chronic subdural haematoma for burr-hole drainage were assessed for eligibility. 108 were randomly assigned by block randomisation to receive a drain inserted into the subdural space and 107 to no drain after evacuation. The primary endpoint was recurrence needing redrainage. The trial was stopped early because of a significant benefit in reduction of recurrence. Analyses were done on an intention-to-treat basis. This study is registered with the International Standard Randomised Controlled Trial Register (ISRCTN 97314294).

FINDINGS

Recurrence occurred in ten of 108 (9.3%) people with a drain, and 26 of 107 (24%) without (p=0.003; 95% CI 0.14-0.70). At 6 months mortality was nine of 105 (8.6%) and 19 of 105 (18.1%), respectively (p=0.042; 95% CI 0.1-0.99). Medical and surgical complications were much the same between the study groups.

INTERPRETATION

Use of a drain after burr-hole drainage of chronic subdural haematoma is safe and associated with reduced recurrence and mortality at 6 months.

FUNDING

Academy of Medical Sciences, Health Foundation, and NIHR Biomedical Research Centre (Neurosciences Theme).

Chronic subdural hematomas--causes of morbidity and mortality

OBJECTIVE

Chronic subdural hematoma is a very common condition seen usually in the later stages of life. Treatment, although apparently simple, is associated with some morbidity and mortality with a potential for recurrence. This is especially important as the average life span of humanity increases all over the world.

METHODS

A retrospective analysis of 647 cases of chronic subdural hematomas treated in NIMHANS was done. The aim of this study was to determine the factors responsible for the morbidity, mortality, and recurrence in patients with chronic subdural hematomas.

RESULTS

The patients were mostly men in the sixth and seventh decade of life and presented with headache, cognitive decline, or focal deficits. CT scan was done in all cases. 94% of the patients underwent evacuation of the hematoma. There was a mortality rate of 5%, and there was a recurrence of 21%. Statistical analysis for factors both for mortality and morbidity were done.

CONCLUSIONS

It was seen that statistically significant factors determining mortality were age, GCS at presentation, and associated illnesses like cardiac and renal failure. The statistically significant factors for recurrence are the presence of a thick subdural membrane visualized during surgery and brain, remaining at a depth at the end of evacuation of hematoma. Use of a subdural drain significantly reduced recurrences. The chronicity of the hematoma was not a factor determining mortality or morbidity. Drains were seen to significantly reduce recurrence in younger patients with better GCS and when the subdural membrane is seen at surgery and the brain remains at a depth at the end of hematoma evacuation.

Chronic subdural hematoma: comparison of two surgical techniques. Preliminary results of a prospective randomized study

AIM

The optimal treatment for chronic subdural hematoma (CSDH) is not yet well defined and research for efficient surgical solutions continues. Burr hole craniotomy (BHC) is a common treatment and twist drill craniostomy (TDC) is a less invasive alternative. A closed-system drainage with subdural expansion catheter and suction reservoir can be used to enhance the TDC procedure.

METHODS

We report preliminary results of a prospective study comparing BHC and TDC with suction drainage, in a series of 47 patients randomized into two treatment groups. One group of 22 patients underwent TDC with closed-system drainage and suction reservoir (14 men, 8 women, mean age 78.7 years). Another group of 24 patients underwent BHC with subdural irrigation and closed drainage (16 men, 8 women, mean age 76.3 years). Neurological status was assessed by Markwalder's Grading Scale on admission and at follow-up. All patients underwent computed tomography (CT) before surgery, within 4 days after it, and 1 and 2 months later.

RESULTS

Preoperative clinical and radiological data were similar in the two groups. Operating times were shorter in the TDC group, while drainage time was shorter in the BHC group (P<0.0001). Length of hospitalization was similar. Recurrence rate, mortality, and neurological recovery were similar, with non significant differences in favor of the TDC group. After 2 months, CT showed complete regression of subdural effusion in 66.6% of cases in the TDC group and in 31.8% in the BHC group (P<0.05).

CONCLUSIONS

Preliminary results indicate TDC and BHC as at least equally effective, however TDC favors faster regression of residual subdural effusion, is a faster procedure, and seems to be associated with fewer recurrences. If confirmed at the end of the study, these results could indicate TDC with suction as the elective surgical treatment for CSDH.

Chronic subdural hematoma: results of a homogeneous series of 159 patients operated on by residents

AIMS

A series of cases with chronic subdural hematoma operated upon by residents in neurosurgery is analysed.

MATERIALS AND METHODS

159 patients treated between 1998 and 2001 were included in the study. Mean age was 76.4 years and male/female ratio was 1.7/1. The patients were classified both on admission and at discharge according to the Markwalder scale. The standard operative procedure consisted of an enlarged single burr-hole, rinsing the subdural space with iso-osmotic saline solution and insertion of a subdural drain.

CONCLUSION

In CSDH, operation by the residents is safe and the results are comparable to those of the major series of the literature as the surgical procedure is standardized.

[Chronic subdural hematoma: study of 161 patients and the relationship with coagulation abnormalities]

The chronic subdural hematoma represents one of the most frequent types of intracranial hemorrhage. One hundred sixty one patients operated in the Clinical Hospital of State University of Campinas-SP (UNICAMP) from April 1994 to May 2000, were analyzed retrospectively in order to characterize the population and to study the importance of the pre-operative coagulation analysis in the outcome. The majority of the population was male (86%), white (85.1%) and in the fifth decade (median age: 57 years). A high mortality index in the postoperative period was found in patients with INR (international normalized ratio) values greater than 1.25 and/or thrombocytopenia (p<0.001 and p=0.004 respectively). Patients with previous head injury history (76%) showed a lower mortality (p=0.044). The results stand out the importance of the pre-operative evaluation with coagulation studies in order to correct possible abnormalities.

[Chronic subdural hematoma: a disease of elderly people]

BACKGROUND

The lack of specificity and heterogeneity of the clinical picture of chronic subdural hematoma, hampers its diagnosis.

AIM

To report the experience of a Neurosurgical Service in chronic subdural hematoma.

PATIENTS AND METHODS

One hundred patients (77 male, mean age 77 +/- 13 years) with chronic subdural hematoma were analyzed.

RESULTS

The main clinical presentations were mental status changes (50%) and progressive focal neurological deficit (46%). Five cases presented as a transient neurological deficit. All patients were treated with burr hole drainage. Thirteen had recurrence of the hematoma and they were reoperated. The surgical mortality was 3%. Eighty seven patients were followed for a mean of 66 months. Eighty one of these had a complete recovery, 6 had permanent neurological deficit and 2 of these were unable to care for themselves. Bad prognosis was associated with the absence of a previous trauma to explain the hematoma and symptoms of dementia as the clinical presentation.

CONCLUSIONS

Most patients with chronic subdural hematoma treated with burr hole drainage have a good outcome.

Chronic subdural haematoma in the elderly--a North Wales experience

Chronic subdural haematoma (CSDH) is predominantly a disease of the elderly. Most of the existing data come from studies done several decades ago. We examined the incidence, risk factors, clinical presentation, management and outcome in elderly patients with CSDH by retrospective study of the period 1996-1999 in the three district hospitals of North Wales. 40 cases of CSDH were identified in patients >65 years, the incidence in this population being 8.2/100,000. Falls (57%) and antithrombotic therapy (33%) were the most frequent risk factors. The most common presenting features were altered mental state (52%) and focal neurological deficit (50%). 24 patients (60%) underwent surgical intervention with 4 deaths (17%). In the non-operated group mortality was 7/16 (44%). Most of the deaths in this series were due either to CSDH or to the complications of frailty and poor mobility. Surgery itself was generally successful.

[Complications of chronic subdural hematoma in the adult]

Chronic subdural hematoma is subject to post-operative fatal and non-fatal complications in 5 to 10% of the cases. Mortality ranges from 0 to 8%, depending on the preoperative clinical status. There is an average recurrence in 8% of the cases, chiefly linked to the absence of drainage. Empyema occurs in 2% of patients, especially when the drain is left in place more than 3 days. In most of the series, long-term epilepsy is a rare complication and patients do not require antiepileptic drugs. The lack of cortical reexpansion, postoperative intracerebral hematoma and tension hydrocephalus are, among others, complications occurring after surgery. Finally, 10% of the patients will have a permanent neurological impairment.

Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate

Chronic subdural hematoma (CSDH) is one of the most common clinical entities in daily neurosurgical practice. The diagnosis and treatment are well established, but recurrence, complications, and factors related to these problems, especially in the elderly, are not completely understood. This study evaluated the clinical features, radiological findings, and surgical results in a large series of the patients treated at the same institution. 500 consecutive patients (359 men and 141 women) with CSDH were treated by burr hole craniostomy with closed system drainage from January 1987 through February 1999. Causes, clinical and computed tomographic findings, surgical results, re-expansion of brain after surgery, and hematoma recurrence were statistically analyzed to elucidate the potential risks of CSDH. Most patients (89.4%) had good recovery, 8.4% showed no change, and 2.2% worsened. Six patients (1.2%) died, three due to disseminated intravascular coagulation. Recurrence of hematoma was recognized in 49 patients (9.8%), at 1 to 8 weeks (3.5 +/- 1.9 weeks) after the first operation. The brain re-expansion rate at one week after operation was 45.0 +/- 21.4% in patients with hematoma recurrence and significantly lower than 55.3 +/- 19.1% in patients without recurrence (p < 0.001). Old age, pre-existing cerebral infarction, and persistence of subdural air after surgery were significantly correlated with poor brain re-expansion (p < 0.001). Twenty-seven patients (5.4%) suffered postoperative complications, of which 13 cases were acute subdural hematoma caused by incomplete hemostasis of the scalp wound and four cases were tension pneumocephalus. Careful hemostasis and complete replacement of subdural hematoma by normal saline to prevent influx of air into the subdural space will further improve the surgical outcome for patients with CSDH.

Prognosis of chronic subdural hematomas

This article considers factors that may be of prognostic value in evaluating the chronic subdural hematoma (CSH) patient. It also examines conditions that predispose the development of a CSH. Variables such as admission neurologic status and presenting symptomatology are reviewed. Radiologic parameters (i.e., CSH density and midline shift) and intraoperative findings (i.e., pressure and pulse) are discussed.

Chronic subdural hematoma in adult and elderly patients

Chronic subdural hematomas display a wide diversity of features in adults, often simulating other neurologic and psychiatric disease processes. This is particularly problematic in elderly patients, for whom more nonspecific clinical presentations are common. Recognition of these features is the key to early diagnosis in elderly patients, who exhibit a markedly increased incidence of this disease. Prompt diagnosis prevents delays that may lead to increased morbidity in these patients.

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.