Honda Yumie, Sorimachi Takatoshi, Momose Hiroaki, Takizawa Ken, Inokuchi Sadaki, Matsumae Mitsunori
Neurol Res. 2015 Nov;37(11):985-92. doi: 10.1179/1743132815Y.0000000083. Epub 2015 Sep 7.
Detailed features of chronic subdural haematoma (cSDH) associated with disturbance of consciousness and acute-on-chronic subdural haematoma (a/cSDH), in which acute subdural haematoma overlaps cSDH, remain poorly understood. The object of this study was to clarify both characteristics of cSDH associated with disturbance of consciousness and the significance of a/cSDH.
Clinical factors and computed tomography (CT) findings were retrospectively investigated in 349 consecutive patients admitted between 2006 and 2013 and diagnosed with cSDH.
Glasgow Coma Scale (GCS) was ≤ 8 in 21 patients (6.0%) and 9-14 in 29 patients excluding aphasia and/or dementia (8.3%). Multiple logistic regression analysis indicated that a/cSDH, female sex and haemodialysis were significantly related to severe disturbance of consciousness (GCS ≤ 8). Predictors for a/cSDH observed in 29 patients (8.3%) were trauma history within 7 days before admission, high prothrombin time-international rate, and use of anticoagulants and/or antiplatelets. Unfavourable outcomes were observed in 29 of 299 patients (9.7%) without consciousness disturbance, compared to 27 of 50 patients (54%) with consciousness disturbance. Predictors of unfavourable outcome were consciousness disturbance, increase in age, malignancy, trauma history within 7 days and haemodialysis.
Disturbance of consciousness associated with cSDH, often caused by either a/cSDH or concomitant disease, frequently resulted in unfavourable outcomes. As a result, in cSDH patients associated with disturbance of consciousness, underlying conditions, especially a/cSDH, which is often caused by haemostatic abnormality, should be clarified and managed.
与意识障碍相关的慢性硬膜下血肿（cSDH）以及急性硬膜下血肿叠加于cSDH之上的急性-慢性硬膜下血肿（a/cSDH）的详细特征仍未得到充分了解。本研究的目的是阐明与意识障碍相关的cSDH的特征以及a/cSDH的意义。
回顾性研究了2006年至2013年间连续收治的349例诊断为cSDH的患者的临床因素和计算机断层扫描（CT）结果。
21例患者（6.0%）的格拉斯哥昏迷量表（GCS）≤8分，29例排除失语和/或痴呆的患者（8.3%）的GCS为9 - 14分。多因素逻辑回归分析表明，a/cSDH、女性性别和血液透析与严重意识障碍（GCS≤8）显著相关。在29例患者（8.3%）中观察到的a/cSDH的预测因素为入院前7天内的创伤史、高凝血酶原时间-国际标准化比值以及使用抗凝剂和/或抗血小板药物。在299例无意识障碍的患者中，29例（9.7%）出现不良结局，而在50例有意识障碍的患者中，27例（54%）出现不良结局。不良结局的预测因素为意识障碍、年龄增加、恶性肿瘤、入院前7天内的创伤史和血液透析。
与cSDH相关的意识障碍通常由a/cSDH或伴随疾病引起，常导致不良结局。因此，在伴有意识障碍的cSDH患者中，应明确并处理潜在疾病，尤其是常由止血异常引起的a/cSDH。
