Clinical Study of Chronic Subdural Hematoma and Hygroma in Two Hospitals for Elderly Patients with Dementia

Abstract

The authors have investigated the incidence of chronic subdural hematoma and hygroma (CSH) in two hospitals for elderly patients with dementia syndrome over a period of three years and nine months. All observed patients had been in the hospital for 2 weeks or more and had had brain computed tomography (CT) on admission. The total of 613 patients included 212 males and 401 females. Based on the C.T. findings observed in patients on admission, the authors found 47 patients with C.S.H. This was equivalent to 7.7% of all patients observed. After admission, almost all patients had brain C.T. twice per year, with a mean of 2.2 C.T. examinations during the observation period. Sixteen patients who had no C.S.H on admission developed C.S.H. Thus a total of 63 (10.3%) demented patients demonstrated C.S.H during the observation period. It was assumed that the high incidence of C.S.H in this study may be due to the practice of performing routine C.T. examinations in hospitalized patients and the fact that demented patients are prone to fall and hit their heads. From the investigation of past history, tastes, and patterns of daily behavior, we found the risk factors for C.S.H development to be male sex, alcohol abuse and wandering as a symptom of dementia. We performed C.T. examinations on all patients who showed subjective or objective neurosymptoms related to the central nervous system, but we could find only 2 patients with high-density lesions in the subdural space that indicated acute bleeding. This was only 3.1% (2/65) of all patients who developed subdural effusion. Thus, this fact supports the hypothesis that a leak of cerebrospinal fluid might have developed before bleeding in the subdural space in these elderly cases. © 1989, The Japan Geriatrics Society. All rights reserved.