Chronic Subdural Hematoma in Elderly Patients: Is This Disease Benign?

Abstract

As the world population becomes progressively older, the overall incidence of chronic subdural hematoma (CSDH) is increasing. Peak age of onset for CSDH has also increased, and recently the 80-year-old level has a peak. Many patients with CSDH have had prior treatment with anticoagulants and antiplatelet drugs, which have an accompanying risk of CSDH. In elderly patients with CSDH, symptoms of cognitive change (memory disturbance, urinary incontinence, and decreased activity) and disturbance of consciousness at admission were more frequent compared to younger patients with CSDH. The literature actually offers conflicting advice regarding CSDH treatment; however, burr hole surgery with drainage under local anesthesia is the most common surgical procedure, even in elderly patients. The recurrence rate of CSDH has not decreased over recent decades, and it has ranged from 0.36-33.3%. Outcomes in patients over 75 years old was significantly worse than for those younger than 75. Moreover, long-term outcomes for elderly patients with CSDH are poor. CSDH in the elderly is no longer a benign disease. In the future, it will be important for us to understand the mechanisms of onset and recurrence of CSDH and to develop more effective medical treatments and noninvasive surgical techniques for elderly patients.

Keywords: chronic subdural hematoma; epidemiology; long-term outcome; recurrence rate; treatment.

Fig. 1

Chronological change in age distribution of chronic subdural hematoma. Previous studies have reported the etiology of chronic subdural hematoma (CSDH) in Japan. In 1970s, 1980s, and 1990s, most patients with CSDH were in their 50s (- - -), in their 60s (.......), and in their 70s (- - -)) respectively. One most recent study showed that most patients with CSDH were in their 80s (—).