Cases Of Chronic Subdural Hematoma Research Articles

Chronic subdural hematoma that may be caused by nephrotic syndrome: a case report and literature review.

Chronic subdural hematoma (CSDH) is a common complication of neurosurgery. Craniocerebral trauma is the likely cause. There are no reports relating CSDH with nephrotic syndrome. Its pathogenesis is very rare, and there are no previous reports on treatments for this disease. We report a case of chronic subdural hematoma that may be caused by nephrotic syndrome and review the previous literature on this subject. We report a rare case of chronic subdural hematoma that may be caused by nephrotic syndrome. After the patient was admitted to the hospital, relevant laboratory tests were conducted, and a large amount of protein was detected in the patient's urine, indicating hypoproteinaemia and hyperlipidemia. The patient was diagnosed with nephrotic syndrome. After the exclusion of related surgical contraindications, the patient underwent trepanation and drainage of the chronic subdural hematoma. Subsequent treatment with oral atorvastatin was provided after surgery. The patient was transferred to the nephrology department for further treatment of nephrotic syndrome if his neurological condition improved. No neurological sequelae were detected at the follow-up visit 3 months after the operation. Chronic subdural hematomas are rarely caused by nephrotic syndrome. Trepanation and drainage may be considered for patients confirmed to have adequate hematoma liquefaction on imaging and who can tolerate craniotomy. Atorvastatin should be supplemented as prophylactic treatment after the operation. Nephrotic syndrome should be treated as soon as the patient's neurological condition is stable.

Active Versus Passive Drainage Systems for Subdural Hematomas: A Systematic Review and Meta-Analysis.

Chronic subdural hematoma (CSDH) management involves various surgical techniques, with drainage systems playing a pivotal role. While passive drainage (PD) and active drainage (AD) are both used, their efficacy remains contentious. Some studies favor PD for lower recurrence rates, while others suggest AD superiority. A systematic review and meta-analysis were conducted to address this controversy, aiming to provide clarity on optimal drainage modalities post-CSDH evacuation. This systematic review and meta-analysis followed preferred reporting items for systematic reviews guidelines, searching PubMed, Embase, and Web of Science until February 2024. Inclusion criteria focused on studies comparing active vs PD for subdural hematomas. Data extraction involved independent researchers, and statistical analysis was conducted using R software. The assessment of risk of bias was performed using the Risk of Bias in Non-Randomized Studies of Interventions framework and the Risk Of Bias 2 tool. In this meta-analysis, involving 1949 patients with AD and 1346 with PD, no significant differences were observed in recurrence rates between the active (13.6%) and passive (16.4%) drainage groups (risk ratio [RR] = 0.87; 95% CI: 0.58-1.31). Similarly, for complications, infection, hemorrhage, and mortality, no significant disparities were found between the 2 drainage modalities. Complication rates were 7.5% for active and 12.6% for PD (RR = 0.74; 95% CI: 0.36-1.52). Infection rates were available for 635 patients of the active group, counting for 2% and 2.6%, respectively (RR = 0.98; 95% CI: 0.24-4.01). Hemorrhage rates were also available for 635 patients of the active group, counting for 1.1% and 2.2%, respectively (RR = 0.44; 95% CI: 0.11-1.81). Mortality rates were 2.7% and 2.5%, respectively (RR = 0.94; 95% CI: 0.61-1.46). Our study found no significant difference between passive and AD for managing complications, recurrence, infection, hemorrhage, or mortality in CSDH cases. Further large-scale randomized trials are needed for clarity.

Unusual presentation of Chronic Subdural hematoma as Isolated Oculomotor palsy

Isolated oculomotor palsy (ONP) is an unusual presentation in chronic subdural hematomas (CSDH) and is very rare as an initial manifestation. Most commonly, ONP is caused by ischemic microangiopathy, posterior communicating artery aneurysm, uncal herniation, neoplasia, traumatic and/or any inflammatory conditions. ONP in chronic subdural hematoma is a sign of cerebral herniation that is typically associated with a deterioration of consciousness. We describe a case of chronic subdural hematoma that presented with an isolated ONP.

A Case of Chronic Subdural Hematoma Detected in an Asymptomatic Patient during Health Checkup

<p>本案例為68歲女性，日前至本院預防醫學中心進行年度例行性健康檢查。病史詢問時告知四週前有騎機車自摔，並有撞擊到右側顳骨處。於車禍後並無不適或神經功能缺損。理學檢查及神經學檢查皆無異常。後續於健康檢查中的腦部電腦斷層發現雙側慢性硬腦膜下血腫。此案例提醒基層醫師，若病人有頭部外傷史，應小心鑑別診斷慢性硬腦膜下血腫，且有可能以無症狀做為表現。</p> <p> </p><p>This case report highlights the development of bilateral chronic subdural hematoma (SDH) following minor trauma, which was asymptomatic upon presentation. A 68-year-old female patient presented to the preventive medicine center for her annual health examination. History taking revealed a minor head trauma at the right temporal four weeks prior. No discomfort or neurological deficit were noted following the trauma. Physical and neurological examinations showed normal results. A head CT was performed, revealing the presence of bilateral chronic SDH. This case underscores the importance of considering the possibility of chronic subdural hematoma even in the absence of symptoms or neurological deficits. Early detection and appropriate management are essential for ensuring optimal patient outcomes.</p> <p> </p>

Surgical evacuation for chronic subdural hematoma: Predictors of reoperation and functional outcomes

BackgroundAlthough chronic subdural hematoma (CSDH) incidence has increased, there is limited evidence to guide patient management after surgical evacuation. ObjectiveTo identify predictors of reoperation and functional outcome after CSDH surgical evacuation. MethodsWe identified all patients with CSDH between 2010 and 2018. Clinical and radiographic variables were collected from the medical records. Outcomes included reoperation within 90 days and poor (3–6) modified Rankin Scale score at 3 months. ResultsWe identified 461 surgically treated CSDH cases (396 patients). The mean age was 70.1 years, 29.7 % were females, 298 (64.6 %) underwent burr hole evacuation, 152 (33.0 %) craniotomy, and 11 (2.4 %) craniectomy. Reoperation rate within 90 days was 12.6 %, whereas 24.2 % of cases had a poor functional status at 3 months. Only female sex was associated with reoperation within 90 days (OR = 2.09, 95 % CI: 1.17–3.75, P = 0.013). AMS on admission (OR = 5.19, 95 % CI: 2.15–12.52, P < 0.001) and female sex (OR = 3.90, 95 % CI: 1.57–9.70, P = 0.003) were independent predictors of poor functional outcome at 3 months. ConclusionCareful management of patients with the above predictive factors may reduce CSDH reoperation and improve long-term functional outcomes. However, larger randomized studies are necessary to assess long-term prognosis after surgical evacuation.

A chronic subdural hematoma complicating an arachnoid cyst in a juvenile boxer: a rare case report with comprehensive literature review

Introduction and importance: Arachnoid cyst (AC) is the most frequently founded lesion reported in adolescent patients suffering from chronic subdural haematoma (CSDH). Association between these two distinct clinical entities is known for a long time. However, in the literature there are numerous clinical cases that reflect this relationship and few large series that analyze them in detail. Paediatric population is more rarely affected with this association. Case presentation: The authors report the case of AC of incidental discovery complicated with CSDH in 15-year-old male recreational boxer presented with progressive onset of holocranial drug-resistant throbbing headache with favourable clinical course after conservative treatment. Clinical discussion: ACs are a well-known predisposing cause for CSDH after head trauma. In all cases of CSDH in children, the diagnosis of ruptured AC should be considered. Rupture may be spontaneous or following even mild head trauma with rupture of bridging veins causing subdural bleeding as it was seen in our patient who was practicing a full-contact free-sparring sport like boxing sustaining repeated and direct mild head traumas. MRI is recommended to detect small cysts in adolescents with CSDH. The management of these patients remains controversial. Conclusion: This is a rare reported case of CSDH complicating an AC in a juvenile recreational male boxer. This association remains extremely rare in children and adolescents, as evidenced by the rare cases reported in the literature.

Ischaemic Stroke After Chronic Subdural Haematoma: An Uncommon Complication in a Common Disease

Background Chronic subdural haematoma (CSDH) is a common neurosurgical disease, particularly among the elderly, especially those on antiplatelet or anticoagulation with trivial trauma. While anticoagulants/antiplatelets increase the chance of rebleeding in cases of CSDH, discontinuation may increase the risk of stroke in these patients. Case Description We report two cases of CSDH in elderly patients with risk factors who suffered from an ischaemic stroke after undergoing surgery. The first case was an elderly gentleman who had a history of percutaneous coronary intervention, presenting with a CSDH. He developed an anterior cerebral artery infarct in the immediate postoperative period. The second was an elderly gentleman with a history of hypertension presenting with a concomitant left thalamic infarct and large left-sided CSDH. He developed a second middle cerebral artery infarct of the opposite side in the immediate postoperative period. Conclusion The medications used for stroke prophylaxis, that is, antiplatelets and anticoagulants are predisposing factors for the development of CSDH. However, the perioperative period of these patients remains vulnerable to the development of new-onset ischaemic stroke.

Verification of a Three-day Hospitalization Protocol for Chronic Subdural Hematoma Surgery.

Chronic subdural hematoma (CSH) is predominantly a disease of the elderly. Aging societies in advanced countries are seeing the number of CSH cases increasing. We applied a three-day hospitalization protocol for CSH surgery to reduce healthcare costs and more efficiently manage hospital beds. We investigated the clinical factors that influenced prolonged hospitalization. From January 2015 to December 2020, we performed irrigation, evacuation, and drainage of CSH cases in 221 consecutive patients. The χ2 test and logistic regression analysis were conducted to detect clinical factors influencing prolonged hospitalization. A p-value below 0.05 was considered statistically significant. Applying a three-day hospitalization protocol showed no adverse outcomes. Fifty-two (24%) of 221 patients experienced prolonged hospitalization. The χ2 test showed that female gender, atrial fibrillation, alcohol abuse, preoperative consciousness level, verbal function disturbance, and perioperative activities of daily living were significantly related to prolonged hospitalization. Female gender, atrial fibrillation, and alcohol abuse were significant factors in the logistic regression analysis. A three-day hospitalization protocol for CSH is suitable for patient care; however, particular attention needs to be focused on the female gender, atrial fibrillation, and alcohol abuse, all three of which prolong hospitalization.

Recurrent Subdural Hematoma: An Institutional Experience.

Background Chronic subdural hematoma (CSDH) is a common neurosurgical problem, which offers a good outcome following surgery. In many cases, burr hole irrigation and drainage under local anesthesia can provide satisfactory results. However,recurrencecan be a cause for concern for both the surgeon and the patient. While recurrence is not a frequent phenomenon, studies have reported rates of up to 31.6%. Aims and objectives In this study, our objective is to examine a comprehensive range of potential risk factors and provide valuable insights into identifying patients at a higher risk of recurrence to aid in surgical decision-making. Methodology This study employed a prospective and retrospective design, conducted between 2017 and 2021, at Sri Ramachandra Institute of Higher Education and Research. The study received ethical approval from the Institutional Ethics Committee. The research aimed to assess patients who underwent surgery for CSDH, with a particular focus on those who experienced recurrence. Results The average age of patients with recurrence was 71.5 years compared to 65.2 years in the no-recurrence group, but this difference did not show a significant statistical correlation. A significant male predominance was observed, with 27 men and four women affected (out of a total of 147 men and 73 women in the study), resulting in a statistically significant p-value of 0.01.On multivariate analysis, heterogenous subtypes were a significant predictor of recurrence (OR: 8.88, 95% CI: 6.96-16.54, p = 0.01).The mean midline shift in those with recurrence was 11.4 mm compared to 7.09 mm in those without recurrence. This was a statistically significant correlation with a p-value of 0.02.Regarding those with recurrence, 24 patients underwent evacuation using two burr holes, with one placed in the frontal region and another in the parietal region. All of these patients had a subdural drain placed, which was removed on postoperative day 2. The remaining eight patients underwent a mini-craniotomy for evacuation.We had four cases of refractory CSDH, all of whom underwent the second evacuation using burr holes. Three of them underwent evacuation via craniotomy, while the family of the fourth patient did not give consent for the procedure. Conclusion Patient-related factors such as gender, bilateral presentation, and the presence of hypertension and radiological factors such as the presence of heterogenous subtype and a significant midline shift are clues towarda higher chance of recurrence.

Endoscopic Treatment of Chronic Subdural Hematoma Combined with Inner Subdural Hygroma.

A chronic subdural hematoma (CSDH) is a collection of bloody fluid located in the subdural space and encapsulated by neo-membranes. An inner subdural hygroma (ISH) is observed between the inner membrane of a CSDH and the brain surface. We present 6 cases of CSDH combined with ISH treated via endoscopy. Between 2011 and 2022, among the 107 patients diagnosed with CSDH in our institute, 6 patients were identified as presenting with CSDH combined with ISH and were included in this study. Preoperative CT and MRI were performed simultaneously, and endoscopic surgery for aspiration of the hematoma was performed in all cases of CSDH combined with ISH. The mean age of patients was 71 years (range, 66 to 79 years). The patients were all male. In two cases, the ISH was not identified on CT, but was clearly seen on MRI in all patients. The inner membrane of the CSDH was tensive and bulging after draining of the CSDH in endoscopic view due to the high pressure of the ISH. After fenestration of the inner membrane of the CSDH and aspiration of the ISH, the membrane was sunken down due to the decreasing pressure of the ISH. There was one recurrence in post-operative 2-month follow up. The symptoms improved in all patients after surgery, and there were no surgery-related complications. CSDH combined with ISH can be diagnosed on imaging, and endoscopic surgery facilitates safe and effective treatment.

Evaluation of Karnofsky Performance Scale as a Postsurgical Prognosis Criteria in Chronic Subdural Hematoma Cases: Discordance Between Clinical and Radiological Outcomes

Background: Chronic subdural hematoma (CSDH) may cause neurological deficits as well as adverse effects on the patient’s general health status. Although CSDH cases are diagnosed in the advanced age group with a very high rate, clinical findings may not be related only to CSDH. The aim should be related to clinical recovery rather than radiological recovery for these cases. We aimed to evaluate Karnofsky’s score as a measurement criterion of postoperative clinical outcomes in patients with CSDH. Methods: Cases operated for the diagnosis of CSDH were defined retrospectively. The cases that had been operated with this diagnosis were identified by examining the institution database records. Karnofsky scores equivalent to clinical status were performed by examining patient files. Karnofsky scoring before the symptomatic period was determined and compared with the Karnofsky score belonging to the late postoperative period. The clinical and radiological findings of the preoperative and postoperative periods were compared. Independent samples t test was used to reveal the difference between the two groups. Results: Data of 184 cases were evaluated. Seventy-three cases were operated on the left, 51 cases on the right, and 60 cases bilaterally with the diagnosis of CSDH. Burrhole exploration was performed in 119 cases, and a craniotomy was performed in 65 cases. Although a significant decrease in hematoma thickness was detected radiologically in cases operated with the craniotomy method, a more significant improvement was observed in Karnofsky’s score in cases operated with the burrhole method. In younger patients, improvement in Karnofsky’s score was significantly higher. Conclusion: The main aim should be to improve clinical status rather than radiological improvement in the treatment of CSDH cases. In the surgical treatment of these cases, it is possible to encounter a high rate of complications depending on age. It is possible to evaluate the postoperative status rationally with Karnofsky scoring. According to the preoperative Karnofsky scoring, deciding on the surgical technique may help reduce complications.

Recurrence of chronic subdural hematoma due to low-grade infection

Despite the high incidence and multitudes of operative techniques, the risk factors for chronic subdural hematoma (CSDH) recurrence are still under debate and a universal consensus on the pathophysiology is lacking. We hypothesized that clinically inapparent, a low-grade infection could be responsible for CSDH recurrence. This investigation is a single-center prospective observational study including patients with recurrent CSDH. In total, 44 patients with CSDH recurrence received an intraoperative swab-based microbiological test. The intraoperative swab revealed an inapparent low-grade hematoma infection in 29% of the recurrent CSDH cases. The majority (69%) of the identified germs belonged to the staphylococcus genus. We therefore, propose a novel potential pathophysiology for CSDH recurrence.

Emergency Department Visits for Chronic Subdural Hematomas within 30 Days after Surgical Evacuation with and without Middle Meningeal Artery Embolization.

Middle meningeal artery embolization after surgical evacuation of a chronic subdural hematomas is associated with fewer treatment failures than surgical evacuation. We compared emergency department visits within 30 days for patients with chronic subdural hematomas with and without adjunctive middle meningeal artery embolization. All cases of chronic subdural hematoma treated from January 1, 2018, through December 31, 2020, were retrospectively reviewed. Treatment was classified as surgery only or surgery combined with middle meningeal artery embolization. The primary outcome was 30-day emergency department presentation and readmission. Of 137 patients who met the study criteria, 28 (20%) underwent surgery combined with middle meningeal artery embolization. Of these 28 patients, 15 (54%) underwent planned middle meningeal artery embolization and 13 (46%) underwent embolization after surgical failure. The mean chronic subdural hematoma size at presentation in the group with surgery only (n = 109, 20.5 [SD, 6.9] mm) was comparable with that in the combined group (n = 28, 18.7 [SD, 4.5] mm; P = .16). A significantly higher percentage of the surgery-only group presented to the emergency department within 30 days compared with the combined group (32 of 109 [29%] versus 2 of 28 [7%] patients; P = .02). No significant difference was found with respect to readmission (16 [15%] versus 1 [4%] patient; P = .11). Nine patients (8%) in the surgery-only group were readmitted for significant reaccumulation or residual subdural hematoma compared with only 1 patient (4%) in the combined group (P = .40). Surgical evacuation combined with middle meningeal artery embolization in patients with chronic subdural hematoma is associated with fewer 30-day emergency department visits compared with surgery alone.

Випадок нетравматичної субдуральної гематоми

The risk for the development of subacute or chronic subdural hematoma is associated with the widespread use of anticoagulant therapy for both prophylactic and therapeutic purposes. Therefore, the purpose of the study was to carry out clinical and morphological analysis of the case of chronic subdural hematoma associated with the use of antithrombotic therapy to substantiate the pathogenetic links of their relationship. Materials and methods. The case report. The body of a woman with signs of bodily injuries was found in the apartment at the place of residence. The autopsy along the entire length of the vertebral canal revealed a draining thin-layer subdural hemorrhage in the form of layers of liquid dark red blood, which effortlessly filled all the free spaces between the dura mater and arachnoid mater. The bones of the vault, the base and the frontal skeleton of the skull were intact. The dura mater was moderately tense, grayish in color, with the bones of the skull tightly fused in all parts of the skull. On the convex and basal surfaces of both hemispheres of the brain with spread between the hemispheres of the brain, around the cerebellum and trunk with penetration into the large occipital foramen, subdural hemorrhage in the form of layers of thick dark red blood was found. Forensic histological examination of pieces of internal organs revealed hemorrhage under the dura mater of the brain and spinal cord with reactive inflammatory changes, deposition of hemosiderin granules. Forensic toxicological analysis of blood, urine, stomach and small intestine contents, liver and gallbladder and kidneys revealed diclofenac and an unknown substance that might be an anticoagulant; however, it could not be identified by the approved methods due to the limited number of comparison samples. Examination of the corpse in the apartment revealed blisters and ampoules of various drugs in the largest amount of diclofenac, warfarin. Results and discussion. The analysis of the data obtained on the scene, as well as from the medical history, records in the available medical documentation, morphological characteristics of detected hemorrhages, results of forensic toxicological and forensic histological studies have established that hemorrhages might have occurred due to uncontrolled use of diclofenac and warfarin. Conclusion. Subdural hematomas are currently the topical medical and social issue due to the significant growing rate of its incidence. Based on this case, it can be stated that the development of chronic subdural hematoma is caused by the combination of mild trauma and inflammatory response in the damaged dura mater with potentiation of hematoma formation through the use of antithrombotic drugs

Embolization of the Middle Meningeal Artery for the Treatment of Chronic Subdural Hematoma: A Path Less Travelled So Far.

Introduction Chronic subdural hematoma (CSDH) is relatively common and usually encountered in elderly population. With steady increase in life expectancy, incidence of CSDH also is bound to increase proportionately. Though surgery is the treatment of choice and relatively a simpler procedure, recurrence is a cause of concern. Embolization of the middle meningeal artery (MMA) is a newly evolving treatment modality in CSDH and offers hope in some of the recently published case series. Materials and Methods Five cases of CSDH were subjected to embolization of MMA over a period from October 2019 to July 2020. Among them, it was employed for treatment in four cases after at least two recurrences following surgery, and in one case, it was done as the patient was not fit for surgery. All procedures were done under general anesthesia and polyvinyl alcohol (PVA) particles were used for embolization. Follow-up of the patients were done with computed tomography brain at 4 weeks and after 6 months of the procedure. Results There was no incidence of recurrence in our series. Furthermore, embolization per se did not cause any complication or side effect which could be directly attributable to the procedure itself. Conclusion In carefully selected patients based on clinical profile and angiographic findings, MMA embolization can be an effective modality for the treatment in CSDH.

Decline in the Incidence of Chronic Subdural Hematoma During the Coronavirus Disease 2019 Pandemic: A Retrospective Single-Center Descriptive Study.

The coronavirus disease 2019 (COVID-19) pandemic has forced restrictions on social activities in some areas. There has also been a decrease in the number of trauma patients in the United States during the COVID-19 pandemic. Chronic subdural hematoma (CSDH) is a traumatic disorder that often develops following head injury. We therefore investigated the impact of the COVID-19 pandemic on CSDH. In this retrospective single-center descriptive study from April 2018 through September 2021, there were 5,282 head trauma patients and 196 patients with CSDH in the pre-pandemic group compared to 4,459 head trauma patients and 140 patients with CSDH in the intra-pandemic group. Significant decreases in the incidence rate (IR) of head trauma (951/100,000 vs. 795/100,000 person-years; IR ratio (IRR): 0.836, 95% confidence interval (CI): 0.803–0.870, p < 0.001) and also in the IR of CSDH (35.0/100,000 vs. 24.8/100,000 person-years, IRR: 0.708, 95% CI: 0.570–0.879, p = 0.002) were seen in the intra-pandemic group compared to the pre-pandemic group. In this study, the COVID-19 pandemic was associated with significant decreases in the IRs of head trauma and CSDH due to forced restrictions on social activities. Besides, the IR of mild cases of CSDH was significantly lower in the intra-pandemic group than in the pre-pandemic group (IRR: 0.68, 95% CI: 0.51–0.89, p = 0.006). Fewer people being out in communities should result in fewer chances for head trauma and CSDH. On the other hand, forced restrictions on social activities due to the COVID-19 pandemic should aggravate CSDH.

Middle meningeal artery embolization with N-Butyl Cyanoacrylate (NBCA) for the treatment of chronic subdural hematoma – Technical note

Chronic subdural hematoma (cSDH) is classically defined as a collection of blood in the space between the dura mater and arachnoid meninges. Endovascular treatment for selected cases of chronic subdural hematoma has been increasingly reported in the literature, being the embolization of the middle meningeal artery (MMA) the most used technique, though the best embolization material is still subject to studies. Methods: we present the detailed description of the technique for MMA embolization with a 20% solution of NBCA for the treatment of chronic subdural hematoma. Discussion: Endovascular treatment for selected cases of chronic subdural hematoma has been increasingly reported in the literature, being the embolization of the MMA the most used technique, though the best embolization material is still subject to studies. NBCA is a low-cost embolic agent that has been used for a long time in endovascular treatments. Conclusion: There is great potential for MMA embolization in the management of chronic subdural hematomas, either as a single or adjuvant treatment. NBCA represents an effective and low-cost material.

Experience with Atorvastatin in Conservative Management of Chronic Subdural Hematoma with Brief Review of Literature

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical procedure done in any neurosurgical unit worldwide. The majority of CSDH are operated upon and there are very few studies regarding its conservative management. Mannitol, Steroids, Tranexemic acid, middle meningeal artery embolization and Angiotensin Converting Enzyme inhibitors are some options to treat CSDH conservatively. Atorvastatin is one of the newer and novel drugs that has been used effectively to medically treat CSDH.&#x0D; This is a retrospective study of 20 cases of CSDH that were managed conservatively with atorvastatin between 2015 to 2021.&#x0D; A total of 20 (7.5%) cases were included in the study period (January 2015 – January 2021). Glasgow Coma Score (GCS)/ Markwalder score (MS), mode of injury if any, age, sex, symptoms and neurological findings, co-morbidities, anti-platelet use, radiological finding of midline shift at admission and outcome with Glasgow outcome score (GOS) at the end of two months after treatment recorded. Atorvastatin in dose of 20 mg daily was given for maximum of two months with repeat CT/MRI scans done at 2 months. Repeat scan was done at 2 weeks and at 2 months and all of them showed complete resolution of the CSDH radiologically. The Glasgow outcome score showed good improvement in all the cases although there was mild confusion in five of the elderly which can be attributed to age related behavior changes.&#x0D; We conclude that atorvastatin can be used safely in not only elderly but also in younger subjects.

Comparing the outcome of 3 different types of operative techniques practiced for chronic subdural hematoma

Chronic subdural hematoma is a common condition of the neurosurgical department requiring surgical intervention. This is a retrospective study of Fifty cases of chronic subdural hematoma (CSDH) patients treated at SGT Medical College, Hospital, and Research Institute were enrolled in this study. The patients were divided into three groups based on the surgical technique performed: single bur-hole drainage (group A, n=40), double bur-hole drainage (group B, n=5), or craniostomy[Twist drill] with evacuation of hematoma (group C, n=5). The results of this study shows that craniostomy[Twist drill] with the evacuation of hematoma in CSDH patients significantly reduced the risk of recurrence, regardless of the number of burr holes used. We, therefore, recommend the use of craniostomy[Twist drill] with the evacuation of hematoma in CSDH patients.

Comparison of Two Drainage Systems on Chronic Subdural Hematoma Recurrence.

Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage, especially among the elderly, with a recurrence rate as high as 33%. Little is known about the best type of drainage system and its relationship with recurrence. In this study, we compare the use of two drainage systems on the recurrence rate of CSDH. We retrospectively analyzed the charts of 172 CSDH patients treated with bedside twist drill craniostomy (TDC) and subdural drain insertion. Patients were divided into two groups: group A (n = 123) received a pediatric size nasogastric tube [NGT]), whereas group B (n = 49) had a drain commonly used for external ventricular drainage (EVD). Various demographic and radiologic data were collected. Our main outcome was recurrence, defined as symptomatic re-accumulation of hematoma on the previously operated side within 3 months. In all, 212 cases of CSDH were treated in 172 patients. The majority of patients were male (78%) and had a history of previous head trauma (73%). Seventeen cases had recurrence, 11 in group A and 6 in group B. The use of antiplatelet and anticoagulation agents was associated with recurrence (p = 0.038 and 0.05, respectively). There was no difference between both groups in terms of recurrence (odds ratio [OR] = 1.42; 95% confidence interval [CI]: 0.49-4.08; p = 0.573). CSDH is a common disease with a high rate of recurrence. Although using a drain postoperatively has shown to reduce the incidence of recurrence, little is known about the best type of drain to use. Our analysis showed no difference in the recurrence rate between using the pediatric size NGT and the EVD catheter post-TDC.