1/31/13

Chronic Subdural Hematoma: Mortality soon after Drainage

Learn why 5 percent of patients die within 30 days of treatment for chronic subdural hematoma.

For this article I consulted with Ivan Mikolaenko, M.D., a board certified neurologist with subspecialty certification in neurocritical care, Neurological Surgery, P.C., New York.

Just prior to my mother undergoing the 15-20 minute drainage procedure for her chronic subdural hematoma, the neurosurgeon (not Dr. Mikolaenko) told me that the biggest risks were infection and recurrence. He made no mention of a mortality rate for the noninvasive procedure.

However, I’ve read in several online neurosurgery journals that there’s a well-documented mortality rate in patients within 30 days of the burr hole drainage of their chronic subdural hematoma. One study said a 5 percent mortality rate. Another said a 6 percent mortality rate out of the 157 patients investigated.

Dr. Mikolaenko explains, “Although most of cSDHs often appear innocuous, severe complications may occur and those include:

“-Devastating intracerebral hemorrhage due to rapid brain decompression leading to hyperemia (increased blood flow) immediately beneath the hematoma or at any other area of the brain which was shifted and compressed for many days before surgery.

“-Failure of the brain to re-expand, especially in patients with pre-surgery low subdural fluid collection pressure: These people very often will have re-accumulation of the subdural fluid.

“-Intractable seizure post-op with or without status epilepticus.

“-Longstanding cSDH with conversion to subdural empyema (collection of subdural pus).

“-Untreated severe pneumocephalus (collection of bubble of air in place of evacuated subdural collection).”

As frightening as this mortality information all sounds to anyone who’s been diagnosed with a cSDH, it’s very important to realize that the mortality rate is still relatively low.

If you’ve hit your head recently, or know someone who has, be on the very vigilant lookout for any new-onset suspicious symptoms. This includes out-of-character change in mood, memory issues, weakness, change in gait pattern, apathy, sudden headaches, or anything that just doesn’t seem right with the individual.

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