gms | German Medical Science

Objective: In an aging population the prevalence of demential syndroms increases dramatically. Chronic subdural hematomas (CSH) are a surgically treatable cause for dementia and cognitive decline. However, little is known about age-dependent predominant symptoms and age-adjusted rates of restoration of functional integrity in this population. To evaluate clinical symptoms and course of disease in patients in different life decades we reviewed the clinical charts of all patients with chronic subdural hematomas in our clinic in the last 20 years.

Method: 697 patients with CSH (male 467, female 223; mean age 70.2 years) which were operated in our department between 1992 and 2013 were included in our retrospective analysis. Patient charts were analyzed for demographical data, neurological presentation and outcome, kind and numbers of surgery, radiological findings, length of hospital stay, procedure-related complications, anticoagulation and history of trauma. Subgroup analysis was performed according to age (age-group AG): 1) <65 years, 2) 66–75 years, 3) 76–85 years, 4) 86–95 years and 5) >96 years.

Results: Most of the patients were treated by burr hole trephination and implantation of a subdural drainage (96.5%; n=673). The mean thickness of the CSH was 2.1cm in the total cohort. There was a significantly increased CSH-thickness with growing age (p=0.014). The surgery-related morbidity was 4.8% (n=33), the in-hospital mortality was 1.4% (n=10). There was no significant difference between the age-groups concerning the surgical technique and the complication rates, but patients in AG 3-5 had a significant higher number of reoperations (p=0.001). Preoperatively the most common symptoms were headache in AG 1 and 2 (45.0% and 47.7%, resp.) and cognitive decline in AG 3-5 (53.8%, 50.0% and 50.0% resp.). After surgery the clinical symptoms of CSH ameliorated significantly in all age-groups. The most common clinical residuum were motor deficits in AG 1 (9.0%), mnestic deficits in AG 2 (10.1%), AG 4 (21.7%) and AG 5 (25.0%) and organic brain syndroms in AG 3 (14.5%).

Conclusions: In our patient cohort the CSH caused predominantly unspecific symptoms like headache and cognitive decline. Surgical treatment of the hematoma led to an immediate symptom relief in patients of all age. However, our data showed significant improvement rates depending on patient's age. This should be considered when patients and relatives are advised on surgical treatment of CSH.