Background and Purpose: To evaluate the role of
preadmission conditions, dehydration specifically, in the development of
subdural hematoma in the elderly. Methods: Retrospective chart review. Results:
The most prevalent pre-admission medical condition was hypertension, followed
by atrial fibrillation, CAD, hyperlipidemia, diabetes, and cancer. Out of 95 patients,
69 (73%) had features of dehydration, 27% were on diuretics and 28% were on
antiplatelet agents and anticoagulation. Conclusions: Elderly population is
prone to dehydration. Overzealous use of diuretics especially in combination
with anticoagulation or antiplatelet therapy can contribute to the development
of subdural hematomas, both spontaneous and traumatic.
References
[1]
Fiki, M.E. (2012) Acute traumatic SDH outcome in patients older than 65 years. World Neurosurgery, 78, 228-230. http://dx.doi.org/10.1016/j.wneu.2012.02.049
[2]
Chen, W. and Grafe, M. (1992) Unsuspected meningioma presenting as a subdural hematoma. Journal of Neurology, Neurosurgery & Psychiatry, 55, 167-168. http://dx.doi.org/10.1136/jnnp.55.2.167-a
[3]
Markwalder, T. (1981) Chronic subdural hematomas: A review. Journal of Neurosurgery, 54, 637-645. http://dx.doi.org/10.3171/jns.1981.54.5.0637
[4]
Cooper, D.J., Rosenfeld, J.V., Murray, L., Arabi, Y.M., Davies, A.R., D'Urso, P., et al. (2011) The DECRA trial decompressive craniectomy in diffuse traumatic brain injury. NEJM, 364, 1493-1502.
[5]
Ramachdran, R. and Hegde, T. (2007) Chronic subdural hematomas-causes of morbidity and mortality. Surgical Neurology, 67, 367-372. http://dx.doi.org/10.1016/j.surneu.2006.07.022
[6]
Reymond, M. and Marbet, G. (1992) Aspirin as a risk factor for hemorrhage in patients with head injuries. Neurosurgical Review, 15, 21-25. http://dx.doi.org/10.1007/BF02352062
[7]
Dickson, J. and Weavers, H. (2005) The effects of dehydration on brain volume-preliminary results. International Sports Medicine, 26, 481-485. http://dx.doi.org/10.1055/s-2004-821318
[8]
Marshall, S. and Hinman, F. (1962) Subdural hematoma following administration of urea for diagnosis of hypertension. JAMA, 182, 813-814. http://dx.doi.org/10.1001/jama.1962.03050460105017
[9]
Akioka, N., Fukuda, O., Takaba, M., Kameda, H., Saito, T. and Endo, S. (2007) Clinical investigation of acute spontaneous SDH cases. Journal of Stroke and Cerebrovascular Disease, 16, 109-113. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2006.11.007
[10]
Nielsen, S., Nagelhus, E.A., Amiry-Moghaddam, M., Borque, C., Agre, P. and Ottersen, O.P. (1997) Specialized membrane domains for water transport in glial cells: High-resolution immunogold cytochemistry of aquaporin 4 in rat brain. Journal of Neuroscience, 17, 171-180.
[11]
de Groot, B.L. and Grumbmuller, H. (2001) Water permeation across biological membranes: Mechanism and dynamics of aquaporin 1. Science, 294, 2353-2354. http://dx.doi.org/10.1126/science.1062459
[12]
Murakami, H. and Hirose, Y. (2002) Why do chronic SDH continue to grow slowly and not coagulate? Role of thrombomodulin in the mechanism. Journal of Neurosurgery, 96, 877-884. http://dx.doi.org/10.3171/jns.2002.96.5.0877
[13]
Basaldella, L., Perin, A., Orvieto, E., Marton, E., Itskevich, D., Dei Tos, A.P., et al. (2010) A preliminary study of aquaporin 1 immunolocalization in chronic subdural hematoma membranes. Journal of Clinical Neuroscience, 17, 905-907. http://dx.doi.org/10.1016/j.jocn.2009.11.010
[14]
Manley, G.T. and Fujimura, M. (2000) Aquaporin-4 deletion in mice reduces brain edema after acute water intoxication and ischemic stroke. Journal of Natural Medicines, 6, 159-163.
[15]
Miglati, E., Meurice, N., DuBois, P., Fang, J.S., Somasekharan, S., Beckett, E., et al. (2009) Inhibition of AQP-1 and AQP-4 water permeability by derivative of the loop diuretic bumetamide acting at an internal pore occluding binding site. Molecular Pharmacology, 76, 105-112.
[16]
Miranda, L. and Braxton, E. (2011) Chronic subdural hematoma in the elderly: Not a benign disease. Journal of Neurosurgery, 114, 72-76. http://dx.doi.org/10.3171/2010.8.JNS10298
