Treatment outcome in patients with chronic subdural hematoma with reference to age and concurrent internal diseases

: The chronic subdural hematoma (CSH) is a disease in elderly patients beyond the 5th decade. Treatment of CSH is normally a burr hole trephination and subdural drainage. Although this technique is simple, lethality is reported to be up to 20% in literature. The records of 314 patients with CSH were analyzed. Attention was focussed on complicating diseases and distribution of age. Patients were categorized neurologically before and after trephination using the Bender scale. The portion of patients suffering from cardiological diseases was 14.3%, 6.7% were treated by anticoagulants because of cardiac valve implant. Alcoholics were found in 15.9% of patients and hypertension in 12.8%. Complicating diseases were found in 51.3% of patients. Multiple internal diseases are likely to affect prognosis more than hematoma thickness. These patients also brought about a higher rate of infection (4.8%), secondary hemorrhages (2.5%), pneumonia (3%) and seizures (5%) after trephination. Lethality was highest in patients with diabetes mellitus, cardiogenic diseases and hypertension as well as in elderly patients. The latter have also a poor post-operative outcome: 22 patients died. In contrast to hematoma thickness and midline shift, which do not have any influence on outcome, prognosis is mainly determined by age, complicating diseases, hypertension and diabetes mellitus. The chronic subdural hematoma is often found in multi-morbid patients.