However, in the US and UK, the rate of conservative treatment of CSDH in elderly patients was higher To accurately and timely evaluate the severity and development trend of patients with CSDH, Markwalders team proposed the Markwalders grading scale and Glasgow Coma Scale (MGSGCS scale) based on the comprehensive consideration of clinical symptom severity and consciousness state score of patients, as shown in Table 1 [16]. also reported that in patients over 90 years old with CSDH, only 24% of them returned home However, many immune inflammatory cells, inflammatory factors, and other inflammatory reaction products are present in the hematoma wall and cavity of CSDH [35]. Wang B, Sun L, Tian Y, Li Z, Wei H, Wang D, et al. J Neurol Sci. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. By using this website, you agree to our There have been no evidence-based reports or guidelines about the timing of surgery in the treatment of CSDH in elderly patients; however, it is better to operate as soon as possible after a neurological deficit appears to increase the likelihood of good operative outcomes J Neurosurg. Surgery or mannitol treatment. Peak age of onset for CSDH has also increased, and recently the 80-year-old level has a peak. However, a hematoma develops slowly, and elderly patients with CSDH often have multiple intracranial volume compensation factors, such as brain atrophy. reported that the recurrence rate of CSDH in patients receiving antiplatelet agents was significantly associated with recurrence Burr hole surgery (BHS) with drainage under local anesthesia is the most common surgical procedure, even in elderly patients In this consensus, the evidence quality is divided into four levels: high, moderate, low, and very low, and the recommendation level is divided into two levels: strong recommendation and weak recommendation. Nathan S, Goodarzi Z, Jette N, Gallagher C, Holroyd-Leduc J. Anticoagulant and antiplatelet use in seniors with chronic subdural hematoma: systematic review. Miranda et al. Katano H, Kamiya K, Mase M, Tanikawa M, Yamada K. Tissue plasminogen activator in chronic subdural hematomas as a predictor of recurrence. Crown Copyright 2019. and Fujitani et al. Epub 2015 Aug 14. reported that outcomes in patients over 70 years old were significantly worse than in those under 70 years old Since then, clinical reports are available on the application of high-dose dexamethasone to promote CSDH absorption and prevent a postoperative recurrence. The dose of atorvastatin can be increased properly when the blood lipid of patients is still elevated during the treatment period. Up to now, the exploration of drug therapy to promote CSDH absorption has gone through a long developmental process. Mortality rate of CSDH in the hospital has been shown to be between 0.21% and 27.5% eCollection 2023. After CSDH hematoma is completely absorbed, patients previous use of anticoagulant and antiplatelet drugs should be restored and the coagulation function should be closely monitored. Acta Neurochir (Wien). statement and . We thank the members of the Chinese Society of Neurosurgery, Chinese Medical Association, for giving the advises to this review, including Zhou Fei, Hua Feng, Guodong Gao, Jiehe Hao, Lijun Hou, Jin Hu, Ying Huang, Baohua Jiao, Hongming Ji, Xiaochun Jiang, Dezhi Kang, Jianrong Li, Xingang Li, Jinfang Liu, Ning Liu, Xianzhi Liu, Ying Mao, Yan Qu, Wai Sang Poon, Ning Su, Tao Sun, Xiaochuan Sun, Jianjun Wang, Renzhi Wang, Junji Wei, Shuo Wang, Gangfeng Yin, Chao You, Rutong Yu, Xinguang Yu, Xianrui Yuan, Jianmin Zhang, Junyi Zhang, Shiguang Zhao, Yuanli Zhao, Zongmao Zhao, Chunlong Zhong, Xide Zhu, Xingen Zhu, Rongcai Jiang, Dong Wang, Ye Tian, Huijie Wei, Wei Quan, Chuang Gao, Shuyuan Yue, Ping Lei, Quanjun Deng, Shu Zhang, Yuan Zhou, Jian Sun, Shuo An, Yingsheng Wei, and Xintong Ge. Inclusion in an NLM database does not imply endorsement of, or agreement with, Google Scholar. Article Tsermoulas G, Shah O, Wijesinghe HE, Silva AHD, Ramalingam SK, Belli A. Accessibility The recommended drugs for CSDH treatment in this consensus are atorvastatin and dexamethasone. Before ; however, most studies have shown that the recurrence rate was around 1015% Because CSDH is often seen in the elderly, patients are weak and have many basic diseases, leading the long-term mortality rate is high. CT scan and MRI can help make a definite diagnosis. 3133) Surgical treatment is usually the first choice for patients with CSDH having a significant space-occupying effect. https://doi.org/10.1001/jamaneurol.2018.2030. Chronic subdural hematoma (CSDH) is a chronic space-occupying lesion formed by blood accumulation between arachnoid and dura mater, which is usually formed in the third week after traumatic brain injury. As a library, NLM provides access to scientific literature. Springer Nature. 3,7) 65) The overall recurrence rate was 10.1%. doi: 10.1136/bmjopen-2021-050786. In some patients with disturbance of consciousness, acute subdural hematoma may overlap with CSDH. 24) 61,62) Surg Neurol Int. https://doi.org/10.1016/j.jns.2016.01.017. and transmitted securely. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Kudo et al. For children, please refer to the literature [33]. The use of opioid drugs should be reduced. 52) https://doi.org/10.1017/cjn.2015.393. Google Scholar. How long it takes to recover varies . In 1992, Kudo et al. 46) 4,8,1119) The level of circulating endothelial progenitor cells may be associated with the occurrence and recurrence of chronic subdural hematoma. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Li T, Wang D, Tian Y, Yu H, Wang Y, Quan W, et al. https://doi.org/10.3171/2014.5.JNS132715. 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. Article De Bonis P, Trevisi G, de Waure C, et al. However, the application of the aforementioned drugs may cause serious side effects, and patients need to be informed of the risk when the drugs are used for a long time. In the 1970s, the age of onset was most commonly 50 years old, Aromatario M, Torsello A, D'Errico S, Bertozzi G, Sessa F, Cipolloni L, Baldari B. Medicina (Kaunas). Takizawa K, Sorimachi T, Ishizaka H, et al. Ooba et al. According to the recent literature, the incidence of CSDH has been progressively increasing, and the long-term outcomes of CSDH patients are poor in spite of recent various medical and surgical treatments There have been many reports that treatment with antithrombotic drugs increases the incidence of CSDH Role of thrombomodulin in the mechanism. 40) Most of the patients showed good results of surgical treatment, but still some patients had a postoperative recurrence (the recurrence rate was up to 33% [2]). Yang W, Huang J. . showed that the incidence of falls in hemodialysis patients who were over 65 years of age was about 1.6 falls/patients-year and fall-related morbidity was high Surgical treatment can bring about rapid clinical improvement with favorable outcomes in 7090% of patients, and there is no significant difference with age. 1981;55(3):3906. https://doi.org/10.1002/phar.2276. 2017;16(3):2114. Pripp AH, Stanisic M. The correlation between pro- and anti-inflammatory cytokines in chronic subdural hematoma patients assessed with factor analysis. Craniotomy Versus Decompressive Craniectomy for Acute Subdural Hematoma: Systematic Review and Meta-Analysis. https://doi.org/10.1016/j.jclinepi.2010.04.026. However, for the elderly and alcoholic patients, the prophylactic use of antiepileptic treatment may be safer and more beneficial [59]. However, a high dose of atorvastatin can not only mobilize more EPC but also significantly increase the expression levels of vascular endothelial growth factor (VEGF), tissue growth factor- (TGF-), and matrix metalloproteinase-9 (MMP-9). More recently, the peak age of onset was shown to be 80 years old according to data from a Japanese national administrative database (Fig. 2016;43(2):28490. Pinggera D, Bauer M, Unterhofer M, Thom C, Unterhofer C. Neurosurg Rev. J Neurol Sci. . The authors report no conflicts of interest. Received 2017 Jan 4; Accepted 2017 Mar 6. The https:// ensures that you are connecting to the Gao C, Gong Z, Wang D, Huang J, Qian Y, Nie M, et al. 2020 Jul 14;11:677. doi: 10.3389/fneur.2020.00677. 1962;6(4):28792. Freeman MW, Singh AK, Guidon AC, Arvikar SL, Goldstein RH, Clement NF. 2018;75(11):133846. FFP, PCC, and recombinant factor VIIa should be considered as possibly treatment options, and reversal with PRADAXA (dabigatran etexilate) (Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA) is also helpful. https://doi.org/10.6061/clinics/2013(08)04. Goto H, Ishikawa O, Nomura M, Tanaka K, Nomura S, Maeda K: Magnetic resonance imaging findings predict the recurrence of chronic subdural hematoma. Zhang, J., Chinese Society of Neurosurgery, Chinese Medical Association, Chinese Neurosurgical Critical Care Specialist Council, Collaborational Group of Chinese Neurosurgical Translational and Evidence-based Medicine. These patients had symptoms associated with increased intracranial pressure such as headache, vomiting, and rapid disturbance of consciousness 27) Therefore, low-dose and long-term treatment of atorvastatin is more suitable for patients with CSDH. 14,58) Epub 2017 Feb 1. Antifibrinolytic drugs can stop bleeding by inhibiting plasminogen activation and plasminogen activity. 28,29) 2011;64(4):38394. It is not confirmed that other brands of atorvastatin and other types of statins also have equivalence. The related contraindications of these two drugs can refer to the product description and are not described in detail. Neurocrit Care. 2006;104(1):7984. Am J Case Rep. 2017;18:9959. Hirakawa K, Hashizume K, Fuchinoue T, Takahashi H, Nomura K: Statistical analysis of chronic subdural hematoma in 309 adult cases. A recent prospective study demonstrated that recurrence rates after BHC were independent of patients head position Clin Neurol Neurosurg. Neurology. https://doi.org/10.3171/jns.2006.104.1.79. Safety and efficacy of atorvastatin for chronic subdural hematoma in Chinese patients: a randomized clinical trial. On the other hand, Wada et al. GRADE guidelines: 1. 1). . 23,25) In patients with systemic coagulation disorders, hemostatic drugs should be used carefully (very low-quality evidence, strong recommendation). World Neurosurg. Craniotomy size for traumatic acute subdural hematomas in elderly patients-same procedure for every age? Elderly women are increasingly being diagnosed eCollection 2020. . reviewed 48 publications about CSDH and indicated a modest average mortality rate of 2.8%. According to the above consensus, the flow chart of CSDH drug treatment is shown in Fig. WebHow Common is SDH? https://doi.org/10.14336/AD.2018.0926. . Stipper et al. Although it is difficult to make the definition of elderly patients in the review article, we mainly review the papers among the patients older than 65 years old. 7) National Library of Medicine 3,4,20,27) CSDH patients were administered a telephone-based assessment including a Demographic Questionnaire, Functional Activities Questionnaire (FAQ), Cognitive Telephone Screening Instrument (COGTEL), Mental Health Continuum-Short Form (MHC-SF), and the Geriatric Depression Scale (GDS). The risk of surgical treatment is high; serious complications and even death Bethesda, MD 20894, Web Policies J Neurosurg. Keywords: . Would you like email updates of new search results? Epub 2017 Jun 26. Therefore, low-dose and short-term use of dexamethasone with atorvastatin is expected to better correct the imbalance between damage factors and repair factors in CSDH. CAS Bilateral CSDH was seen in 9.734.8% of the patients studied PubMed Central Almenawer SA, Farrokhyar F, Hong C, et al. 7,8,15,16,30,50,51) J Clin Epidemiol. . Federal government websites often end in .gov or .mil. For patients who take anticoagulants and antiplatelet drugs for a long time, relevant drugs should be stopped immediately after CSDH is confirmed; it is difficult to stop anticoagulant and antiplatelet drugs due to stent placement, artificial vascular replacement, and heart valve replacement. WebA chronic subdural hematoma (SDH) is an old clot of blood on the surface of the brain beneath its outer covering. The indications of drug treatment for promoting hematoma absorption are as follows: (1) vital signs stable, and MGSGCS grade 02; (2) image showing that the midline shift is less than 1 cm, with no need for emergency surgical intervention; (3) patients having multiple-organ failure, coagulation dysfunction, and other unsuitable or refused surgeries; and (4) the recurrence being prevented after surgery. In clinic, low-dose and short-term dexamethasone treatment refers to the daily dose of 0.53 mg/day, and the duration is no more than 4 weeks (the total dose of dexamethasone is about 60 mg) [33]. Olanzapine is often used to control mental and emotional symptoms, and the dosage of statins should be adjusted for patients with elevated blood lipid levels during the treatment period [58]. The mechanism of CSDH development and absorption is not very clear. Elderly patients with CSDH had a higher recurrence rate compared to younger patients Unable to load your collection due to an error, Unable to load your delegates due to an error. Murakami H, Hirose Y, Sagoh M, Shimizu K, Kojima M, Gotoh K, et al. Why do chronic subdural hematomas continue to grow slowly and not coagulate? However, the incidence of SDH in them has increased to 188.6191/100,000 dialysis patients/year https://doi.org/10.3171/jns.1974.40.5.0639. will be 26,146/year in the entire Japanese population and 13,066/year in those over 80 years old. 2016 Apr;88:569-575. doi: 10.1016/j.wneu.2015.10.045. This rate is 10 times that of the general population, and mortality rate in dialysis patients experiencing SDH is 39%
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