Clinical aspects of chronic subdural hematoma: Presentation, management and outcome

A Chronic Subdural Hematoma (CSDH) is an abnormal accumulation of blood between the dura and arachnoid mater. CSDH is especially present in the elderly and about 75% of patients is male. Risk factors for development of CSDH, besides advanced age and male sex, are use of anticoagulant or antithrombotic drugs and a history of head trauma. The most common symptoms of CSDH are headache, (progressive) hemiparesis, gait disturbances and cognitive deficits. Mainstay of treatment is surgical, with burr hole craniostomy (BHC) and postoperative drainage being the most common. There is an abundance of literature on CSDH, but many facets especially regarding clinical aspects such as treatment presentation and outcome are unclear. Especially the role of cognition in clinical aspects of CSDH is unknown.

This thesis has studied several, mainly clinical aspects of CSDH. The effect of local and general anesthesia during CSDH surgery was studied, together with the primary bilateral surgery of bilateral CSDH. Part of this thesis analyzed the presenting symptoms of CSDH patients and tried to associate these symptoms with functional outcome. Furthermore, in a RCT it was studied whether dexamethasone therapy could be used in the primary treatment of CSDH, or that surgery results in better outcomes. Also, the long term survival and cognitive status of CSDH patients after treatment was analyzed.