Evaluación estadística de los principales factores de riesgo en la producción de hematomas subdurales crónicos

Juan Carlos M. Andreani; Diego Nicolás Rellan Landeira; Walter D’Andrea; Fernando Libenson; Constantino Brignone; Ricardo Fernández Pisani

doi:10.47924/neurotarget2015211

Authors

Juan Carlos M. Andreani Departamento de Neurociencias - Servicio de Neurocirugía. Complejo Médico PFA, Churruca Visca. Argentina.
Diego Nicolás Rellan Landeira Departamento de Neurociencias - Servicio de Neurocirugía. Complejo Médico PFA, Churruca Visca. Argentina.
Walter D’Andrea Departamento de Neurociencias - Servicio de Neurocirugía. Complejo Médico PFA, Churruca Visca. Argentina.
Fernando Libenson Departamento de Neurociencias - Servicio de Neurocirugía. Complejo Médico PFA, Churruca Visca. Argentina.
Constantino Brignone Departamento de Neurociencias - Servicio de Neurocirugía. Complejo Médico PFA, Churruca Visca. Argentina.
Ricardo Fernández Pisani Departamento de Neurociencias - Servicio de Neurocirugía. Complejo Médico PFA, Churruca Visca. Argentina.

DOI:

https://doi.org/10.47924/neurotarget2015211

Keywords:

Anticoagulant treatment, chronic subdural hematoma, hemodialysis, risk factors, statistics

Abstract

Objective: To establish the relative risk of suffering from chronic subdural hematomas in patients anticoagulated,under hemodialysis, or with other risk factors, in a closed medical care system
Introduction: Chronic subdural hematomas are increasingly frequent due to a longer life expectancy and also they present an exponential increase of frequency with age. Their paucisyntomaticy and significant morbi – mortality enhance the need to establish the relative importance of their risk factors to subserve their earlier diagnosis and treatment. Among them, anticoagulation and hemodyalisis are prevalent, but evaluation of their real risk degree is tricky because the difficulty to study their real frequency in greater populations. For this reason statistical works are lacking.
Methods: A cohort of 41 patients, operated of supratentorial chronic subdural hematomas in our surgical unit the last 5 years, were studied and the relative risk factors to suffer this morbid condition were calculated. The evaluated population was 169.275 potential patients, which 988 had chronic anticoagulation treatment, 197 were under hemodialysis and 12564 with antiagregation drugs.
Results: Eight cases had bilateral hematomas, seven patients were under hemodialysis, 15 had anticoagulation, antiagregant treatment in 5, chronic alcoholism 15, recent and severe cranial trauma in 3 patients. Twelve of the anticoagulated patients had had a previous antiagregant treatment. Relative risk value for anticoagulated patients was 104.4 and for renal dialyzed patients was 212.3.
Conclusions: Patients under anticoagulation and renal dialysis might be specially targeted for surveillance, mainly whenever they present a previous history of chronic alcoholism or trauma, moreover if they are older than 60 years.

Metrics

Metrics Loading ...

References

Drapkin, A.J.: Chronic subdural hematoma: pathophysiological basis for treatment. Br J Neurosurg 1991; 5: 467-473.

Delgado-López, P.D.; Martín-Velasco, V; Castilla-Díez, J.M.; Rodríguez-Salazar, A.; Galacho-Harriero, A.M.; Fernández- Arconada, O.: Dexamethasone treatment in chronic subdural haematoma. Neurocirugía 2009; 20: 346-359.

Mori, K., Maeda, M.: Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications and recurrence rate. Neurol Med Chir (Tokyo) 2001; 41: 371-381

Weigel, R., Schmiedek, P., Krauss, J.K.: Outcome of contempo- rary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry 2003; 74: 937-943.

Mori K, Maeda M. Surgical treatment of chronic subdural hema- toma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo). 2001 Aug;41(8):371-81.

Baraniskin A, Steffens C, Harders A, et al. Impact of Pre-Hospital Antithrombotic Medication on the Outcome of Chronic and Acute Subdural Hematoma. J Neurol Surg A Cent Eur Neurosurg. Feb 2013.

Zingale A, Chibbaro S, Florio A, et al. Management of chronic subdural hematoma in patients treated with anticoagulation. J Neurosurg Sci. 1999 Dec;43(4):277-84.

Sood P, Sinson GP, Cohen EP. Subdural hematomas in chron- ic dialysis patients: significant and increasing. Clin J Am Soc Nephrol. 2007 Sep;2(5):956-9.

Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry. 2003 Jul;74(7):937-43

Pencalet P. Clinical forms and prognostic factors of chronic sub- dural hematoma in the adult. Neurochirurgie. 2001 Nov;47(5):469- 72.

Williams GR, Baskaya MK, Menendez J, et al. Burr-hole versus twist-drill drainage for the evacuation of chronic subdural hae- matoma: a comparison of clinical results. J Clin Neurosci. 2001 Nov;8(6):551-4.

Abouzari M, Rashidi A, Zandi-Toghani M, et al. Chronic subdural hematoma outcome prediction using logistic regression and an artificial neural network. Neurosurg Rev. 2009 Oct;32(4):479-84.

Stanišić M, Hald J, Rasmussen IA, Pripp AH, et al. Volume and densities of chronic subdural haematoma obtained from CT imaging as predictors of postoperative recurrence: a prospective study of 107 operated patients. Acta Neurochir (Wien). 2013 Feb;155(2):323-33.

Shrestha P, Pant B, Shrestha P, Rajbhandari P. Organized subdural hematoma with thick membrane in chronic subdural hematoma. JNMA J Nepal Med Assoc. 2012 Jan-Mar; 52(185):1-5.

Rust T, Kiemer N, Erasmus A. Chronic subdural haematomas and anticoagulation or anti-thrombotic therapy. J Clin Neuro- sci. 2006 Oct;13 (8):823-7.

Baechli H, Nordmann A, Bucher HC, Gratzl O. Demographics and prevalent risk factors of chronic subdural haematoma: results of a large single-center cohort study. Neurosurg Rev. 2004 Oct;27(4):263-6.

Ducruet AF, Grobelny BT, Zacharia BE,et al. The surgical man- agement of chronic subdural hematoma. Neurosurg Rev. 2012 Apr;35(2):155-69;

Borger V, Vatter H, Oszvald Á, Marquardt G, Seifert V, Güresir E. Chronic subdural haematoma in elderly patients: a retrospective analysis of 322 patients between the ages of 65-94 years. Acta Neurochir (Wien). 2012 Sep;154(9):1549-54.

Battaglia F, Lubrano V, Ribeiro-Filho T, Pradel V, Roche PH. Incidence and clinical impact of seizures after surgery for chronic subdural haematoma. Neurochirurgie. 2012 Aug;58(4):230-4.

Muangpaisan W, Petcharat C, Srinonprasert V. Prevalence of potentially reversible conditions in dementia and mild cognitive impairment in a geriatric clinic.Geriatr Gerontol Int. 2012 Jan;12(1):59-64.