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Review
. 2017 Aug 15;57(8):418-425.
doi: 10.2176/nmc.st.2017-0058. Epub 2017 Jul 5.

Clinical Characteristics and Outcome in Elderly Patients with Traumatic Brain Injury: For Establishment of Management Strategy

Hiroshi Karibe  1 , Toshiaki Hayashi  1 , Ayumi Narisawa  1 , Motonobu Kameyama  1 , Atsuhiro Nakagawa  2 , Teiji Tominaga  2
Affiliations
Review

Clinical Characteristics and Outcome in Elderly Patients with Traumatic Brain Injury: For Establishment of Management Strategy

Hiroshi Karibe et al. Neurol Med Chir (Tokyo). .

Abstract

In recent years, instances of neurotrauma in the elderly have been increasing. This article addresses the clinical characteristics, management strategy, and outcome in elderly patients with traumatic brain injury (TBI). Falls to the ground either from standing or from heights are the most common causes of TBI in the elderly, since both motor and physiological functions are degraded in the elderly. Subdural, contusional and intracerebral hematomas are more common in the elderly than the young as the acute traumatic intracranial lesion. High frequency of those lesions has been proposed to be associated with increased volume of the subdural space resulting from the atrophy of the brain in the elderly. The delayed aggravation of intracranial hematomas has been also explained by such anatomical and physiological changes present in the elderly. Delayed hyperemia/hyperperfusion may also be a characteristic of the elderly TBI, although its mechanisms are not fully understood. In addition, widely used pre-injury anticoagulant and antiplatelet therapies may be associated with delayed aggravation, making the management difficult for elderly TBI. It is an urgent issue to establish preventions and treatments for elderly TBI, since its outcome has been remained poor for more than 40 years.

Keywords: anticoagulant; antiplatelet; delayed deterioration; elderly; traumatic brain injury (TBI).

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Conflict of interest statement

Conflicts of Interest Disclosure

None of the authors have any conflicts of interest (COI) associated with this study. All authors who are members of The Japan Neurosurgical Society (JNS) have registered online Self-reported COI Disclosure Statement Forms through the website for JNS members.

Figures

Fig. 1
Fig. 1
Interhemispheric subdural hematoma (iSDH).
Fig. 2
Fig. 2
Delayed traumatic intracerebral hematoma. Note: (A) A falco-tentorial and convexity acute subdural hematoma (ASDH) was evident on CT at 1 hour after trauma. (B) The ASDH thickened slightly at 6 hours after trauma. An additional subcortical intracerebral hematoma appeared at right posterior-temporal area.
Fig. 3
Fig. 3
Delayed expansion of ASDH. Note: (A) A thin ASDH was evident on CT at 1 hour after trauma. (B) The hematoma thickened at 6 hours after trauma.
Fig. 4
Fig. 4
Delayed expansion of traumatic intracerebral hematoma. Note: (A) Only a thin ASDH was evident on CT at 1 hour after trauma. (B) A small contusional hematoma appeared at 24 hours after trauma, although the initial ASDH was mostly washed out. (C) The contusional hematoma was fused and enlarged at 48 hours after trauma.
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