Chronic subdural hematoma is one of the most frequent neurosurgical conditions. It is frequently encountered in elderly people (usually, after minor head trauma) and in patients on long-term anticoagulation and long-term hemodialysis. Bilateral chronic subdural hematoma tends to occur more frequently in patients with anticoagulant or antiplatelet therapy.
Innate immune responses play an important role in the pathogenesis of chronic subdural hematoma. The most frequent presenting symptoms are headache, cognitive decline, and focal neurologic deficit. Cognitive decline includes confusional state, psychomotor slowing, gait abnormalities, and subacute dementia. Chronic subdural hematomas often present with atypical and unusual manifestations and can be difficult to diagnose. A high index of suspicion is needed to make the early diagnosis.
Patients require surgical hematoma evacuation. The common surgical procedures for chronic subdural hematoma include twist drill craniostomy, burr hole evacuation, or craniotomy. Endoscopic hematoma evacuation is a safe and effective alternative for clot removal in the elderly. Eighty percent of patients recover completely. Infrequently, hematoma may recur. Tranexamic acid, angiotensin-converting enzyme inhibitors, mannitol, a platelet-activating factor receptor antagonist, and atorvastatin are tried medical treatment options for chronic subdural hematoma; evidence regarding use is limited.
Common predictors of recurrence are male sex, older age, alcohol addiction, surgical treatment, trauma diagnoses, and diabetes mellitus.
In this article, Dr. Ravindra Kumar Garg of King George’s Medical University in Lucknow, India discusses the pathophysiology, clinical presentation, impact on outcome, and available treatments for chronic subdural hematoma.
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