Spontaneous chronic subdural hematoma in elderly people – Arterial hypertension and other risk factors

• Published in: Journal of the Chinese Medical Association 2018-09, Vol.81 (9), p.781-786
• Main Authors: Kostić, Aleksandar, Kehayov, Ivo, Stojanović, Nebojša, Nikolov, Vesna, Kitov, Borislav, Milošević, Predrag, Kostić, Emina, Zhelyazkov, Hristo
• Format: Article
• Language: English
• Subjects: Alcoholism; Blood coagulation disorders; Chronic subdural hematoma; Hypertension; Risk factors
• ISSN: 1726-4901; 1728-7731
• DOI: 10.1016/j.jcma.2018.03.010

The risk factors implicated in the genesis of chronic subdural hematomas include old age, alcoholism, diabetes mellitus, arachnoid cysts, coagulopathy, anticoagulant (ACTh) and antiplatelet drugs. However, no study has reported an association between arterial hypertension (HTA) and chronic subdural hematomas. Therefore, the aim of this study was to investigate whether HTA is a risk factor for spontaneous chronic subdural hematomas (SCSDHs). This multicenter study included patients aged over 60 years and was conducted from January 2009 to the end of 2015. One hundred and twenty-two patients with SCSDHs and 111 controls treated for other reasons with no evidence of intracranial hemorrhages on brain computed tomography were enrolled. The patients were separated into three age subgroups to provide a better insight into the role of risk factors with age. The average age in the SCSDH group was 74.45 ± 8.16 years, compared to 71.28 ± 6.69 years in the control group. The SCSDH group was significantly older than the control group (p = 0.0014). The patients in the 60–69 years age group diagnosed with SCSDHs had significantly higher rates of HTA (p = 0.0519), ACTh treatment (p = 0.0292) and alcoholism (p = 0.0300) than the control group. The patients in the 70–79 years age group diagnosed with SCSDHs had significantly higher rates of HTA (p = 0.0071) and ACTh treatment (p = 0.0158) than the control group. In the subgroup of patients older than 80 years, there were no statistical differences. The incidence of HTA had borderline significance in the patients aged 60–69 years with SCSDHs and statistical significance in the patients aged 70–79 years with SCSDHs. Anticoagulant therapy was the most significant risk factor. Among the patients with SCSDHs aged 60–69 years, the percentage of heavy drinkers was significantly higher than in the control group.