慢性硬膜下血腫の臨床的研究 : 645例の検討

Between January 1982 and October 1991, 645 patients with chronic subdural hematoma were treated at Tokushima University Hospital and its affiliated hospitals. All patients received standard treatment consisting of one burr hole and irrigation. Clinical features in a consecutive series of 645 adult patients with chronic subdural hematoma were studied, comparing two groups: 309 cases classed as elderly of 70 years of age or older (elderly group) and 336 cases below the age of 70 (non-elderly group) . In comparison with the non-elderly group, the elderly group had a higher percentage of females. The reason is considered to be the increase in the number of females in the general elderly population. Left sided hematomas were 1.6 times more common than right sided hematomas. The reason for this discrepancy was believed to be a greater degree of atrophy of the left cerebral hemisphere. An episode of head injury was noted less often in the elderly than non-elderly, so it is also assumed brain atrophy or other conditions caused by aging may play a role in the pathogenesis. In the elderly group, motor weakness and mental disturbance were seen in 66.3 % and 29.4 % respectively. The results were similar to those previously reported. When associated diseases, such as neurodegenerative disease, cerebrovascular disease, dementia and malignancy, are excluded from the analysis, functional prognosis is improved in the non-eldery group. Functional recovery in the elderly tends to be poor in cases with a longer interval between the symptomatic neurological deficit and the operative procedure, while poor operative outcome in the non-elderly group was noted even in cases with a shorter operative interval because of the severity of the condition. It is thought that early diagnosis and surgery would be required in cases of chronic subdural hematoma to obtain good functional recovery regardless of the patient's age.