50 YAŞ ALTINDAKİ KRONİK SUBDURAL HEMATOMU TANILI HASTALARIN İNCELENMESİ

Yıl 2023, Cilt: 86 Sayı: 4, 307 - 311, 01.12.2023

İlyas Dolaş , Tuğrul Cem Ünal , Sefa Öztürk , Cafer İkbal Gülsever , Duran Şahin , Mustafa Selim Şahin , Mehmetzeki Yıldız , Pulat Akın Sabancı , Yavuz Aras , Altay Sencer , Aydın Aydoseli

https://doi.org/10.26650/IUITFD.1219255

Öz

Amaç: Kronik subdural hematom (KSDH) genelde yaşlı popülasyonda ve unilateral olarak izlenir. Bu çalışmada 50 yaşın altında tanı almış KSDH hastalarının klinik özelliklerinin incelenmesi planlandı.
Gereç ve Yöntem: Bu çalışmaya İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Beyin ve Sinir Cerrahisi anabilim dalında 50 yaşın altında bilateral KSDH tanısı almış ve "burr-hole" drenajı ile tedavi edilmiş olan 20 hasta dahil edildi. Hastaların demografik, klinik, radyolojik bilgilerine hastane sisteminden retrospektif olarak ulaşıldı. Tüm veriler IBM SPPS 28.0.0 programı kullanılarak istatiksel olarak değerlendirildi.
Bulgular: Çalışmaya, 14 (%70) erkek ve altı (%30) kadın hasta dahil edildi. Ortalama yaşın 20,5 olduğu görüldü. En sık hastaneye başvurma semptomları incelendiğinde dokuz (%45) hastada baş ağrısı, beş (%25) hastada yeni gelişen parezi ve dört (%20) hastada nöbet geçirme olduğu görüldü. On yedi (%85) hastada kafa travması öyküsünün olmadığı saptandı. KSDH 14 hastada bilateral "burr-hole" ile boşaltıldı. Bu 14 hastanın takiplerinde üçünün (%21,4) ve geri kalan altı hastanın üçünün (%50) rekürren kanama nedeniyle tekrar opere edildiği saptandı.
Sonuç: Çalışmamızda, genç bilateral KSDH tanılı hastalarda travma öyküsünün, antiagregan ve antikoagülan kullanımının az olduğu görüldü. Elli yaş altında karşılaşılan bilateral KSDH etiyolojisini aydınlatmak için daha geniş çaplı çalışmalara ihtiyaç bulunmaktadır.

Anahtar Kelimeler

Burr-hole, kronik subdural hematom, intrakranyal hematom

EVALUATION OF BILATERAL CHRONIC SUBDURAL HEMATOMAS IN PATIENTS UNDER 50 YEARS OF AGE

Öz

Objective: Chronic subdural hematoma (CSDH) is typically seen in elderly people with unilateral hemorrhages. The aim of this study was to examine the clinical outcomes of patients under the age of 50 who were treated at our clinic for bilateral CSDHs.
Material and Method: This retrospective study included 20 patients under the age of 50 who had been diagnosed with bilateral CSDHs and treated with burr-hole drainage between 2000 and 2022 at Istanbul Faculty of Medicine, Department of Neurosurgery, Istanbul University. The patients’ demographic information, clinical data, and radiological images were obtained retrospectively from the hospital system. The data were subjected to descriptive statisticalanalysis using the IBM SPSS statistics 28.0.0 program.
Result: There were 14 (70%) males and six (30%) females in our study, with a mean age of 20.5 years. The most common complaints among the patients were headaches in nine patients (45%), newly developed paresis in five patients (25%), and seizures in four patients (20%). It was discovered that 17 patients (85%) had no history of head trauma. CSDH was evacuated by bilateral burrholes in 14 patients (70%). Three (21.4%) of 14 patients with bilateral burr-holes, and three (50%) of the remaining six patients were reoperated due to recurrent bleeding in the follow-up period.
Conclusion: In our study, trauma history and use of antiaggregants and anticoagulants were low. More comprehensive studies on the etiology of bilateral CSDH in patients under 50 years of age are required.

Anahtar Kelimeler

Burr-hole, chronic subdural hematomas, intracranial hematoma

Kaynakça

• Uckun OM, Divanlioğlu D, Dağlioğlu E, Alagöz F, Dalgiç A, Belen AD. Kronik subdural hematom hastalarında klinik özellikler: travma ve antikoagülan/antiagregan ilaç kullanımı, clinical features in chronic subdural hematoma patients: trauma and anticoagulant / antiagregan drug used. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi 2018;51(3):196:200. google scholar
• Wei Q, Fan G, Li Z, Wang Q, Li K, Wang C, et al. Middle meningeal artery embolization for the treatment of bilateral chronic subdural hematoma. Front Neurol 2021;12:651362. google scholar
• Weigel R, Schilling L, Krauss JK. The pathophysiology of chronic subdural hematoma revisited: emphasis on aging processes as key factor. Geroscience 2022;44(3):1353-71. google scholar
• Bartek J, Sjåvik K, Dhawan S, Sagberg LM, Kristiansson H, Ståhl F, et al. Clinical course in chronic subdural hematoma patients aged 18-49 compared to patients 50 years and above: a multicenter study and meta-analysis. Front Neurol 2019;10:311 google scholar
• Ou Y, Dong, J, Wu L, Xu L, Wang L, Liu B, et al. The clinical characteristics, treatment, and outcomes of chronic subdural hematoma in young patients. World Neurosurg 2019;125:1241-6. google scholar
• Mohamed T, Swed S, Al-Mouakeh A, Sawaf B. Nontraumatic bilateral subdural hematoma: Case report. Ann Med Surg (Lond) 2021;71:102907. google scholar
• Désir LL, D’Amico R, Link T, Silva D, Ellis JA, Doron O, et al. Middle meningeal artery embolization and the treatment of a chronic subdural hematoma. Cureus 2021;13(10):e18868. google scholar
• Huang YH, Yang KY, Lee TC, Liao CC. Bilateral chronic subdural hematoma: what is the clinical significance? Int J Surg 2013;11(7):544-8. google scholar
• Oyama H, Ikeda A, Inoue S, Shibuya M. The relationship between coagulation time and bilateral occurrence in chronic subdural hematoma. No To Shinkei 1999;51(4):325- 30. google scholar
• Kaya M, Ceylan D, Kaçıra T, Tarihi G. Araknoid kistler ile ilişkili subdural hematomlar: iki olgu sunumu. Sakarya Tıp Dergisi 2021;11(3):669-74. google scholar
• Wu X, Li G, Zhao J, Zhu X, Zhang Y, Hou K. Arachnoid cyst-associated chronic subdural hematoma: report of 14 cases and a systematic literature review. World Neurosurg 2018;109:e118-30. google scholar
• Benek HB, Akcay E. Concomitant chronic subdural hematomas and arachnoid cysts in young adults. F1000Res 2021;10:421 google scholar
• Andersen-Ranberg NC, Poulsen FR, Bergholt B, Hundsholt T, Fugleholm K. Bilateral chronic subdural hematoma: unilateral or bilateral drainage? J Neurosurg 2017;126(6):1905-11. google scholar