Bilateral chronic subdural hematoma: what is the clinical significance?

Abstract

Background: Bilateral chronic subdural hematoma (CSDH) is not uncommon, although information on this condition is limited.

Aims: We aim to identify the differences in clinical characteristics between patients with bilateral or unilateral CSDH.

Methods: Ninety-eight patients with CSDH were enrolled in the two-year retrospective study. We investigated neurological outcome, morbidity, mortality, and recurrences after burr hole craniostomy for CSDH.

Results: Bilateral convexity hematomas were identified in 25 of 98 CSDH (25.51%). The patients with bilateral lesions had a lower incidence of hemiparesis than those having unilateral lesions (p = 0.004). Analysis of the neuro-images revealed significant differences in the presence of a midline shift (p = 0.001) and thickness of the hematoma (p < 0.001). The mean Markwalder subdural hematoma grade at admission was 1.89 ± 0.66 and 1.64 ± 0.49 in the unilateral and bilateral hematoma groups, respectively (p = 0.010). After a minimum follow-up period of 6 months, the mean Glasgow Outcome Scale was not significantly different (p = 0.060). The recurrence rate of up to 28.00% observed for the bilateral disease was found to be higher than 9.59% observed for the unilateral disease (p = 0.042).

Conclusion: The frequency of focal neurological deficits was found to be lesser in patients with bilateral CSDH, and it may confound the diagnosis and delay treatment. To prevent neurological deterioration resulting from the thicker hematomas, early surgical decompression for bilateral CSDH should be implemented. Additionally, clinicians must be aware of the higher recurrent rate of bilateral CSDH after burr hole craniostomy.

Keywords: Bilateral; Burr hole; Chronic subdural hematoma; Prognosis; Recurrence.