Risk factors for moderate disturbance of consciousness in patients with unilateral chronic subdural hematoma
Objective: Chronic subdural hematoma (CSDH) patients usually present with mild symptoms; however, a subset of patients presents with disturbance of consciousness (DOC). We analyzed clinical and radiographic factors, which could influence the level of consciousness in CSDH patients before surgery. Me...
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Elsevier
2025-03-01
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| Series: | Interdisciplinary Neurosurgery |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751925000040 |
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| author | Adrian Liebert Thomas Eibl Thomas Bertsch Hans-Herbert Steiner Karl-Michael Schebesch Leonard Ritter |
| author_facet | Adrian Liebert Thomas Eibl Thomas Bertsch Hans-Herbert Steiner Karl-Michael Schebesch Leonard Ritter |
| author_sort | Adrian Liebert |
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| description | Objective: Chronic subdural hematoma (CSDH) patients usually present with mild symptoms; however, a subset of patients presents with disturbance of consciousness (DOC). We analyzed clinical and radiographic factors, which could influence the level of consciousness in CSDH patients before surgery. Methods: We retrospectively analyzed consecutive unilateral CSDH patients, who were surgically treated in our department from 2018 to 2023. We compared a group of patients with moderate DOC (group 1), defined as a Glasgow Coma Scale (GCS) 9–13, with a control group of awake but symptomatic patients (GCS > 13, group 2). Clinical and radiographic parameters were analyzed in bivariate and multivariate analyses. Results: 41 (12.9 %) patients presented with GCS 9–13 and 276 patients with GCS > 13. In bivariate analysis, radiographic parameters, like greater mean midline shift (p < 0.001), homogenous hypodense type (p = 0.017), additional temporal (p < 0.001) and occipital (p < 0.001) location, “acute-to-chronic” (p = 0.002) and “acute-on-chronic” (p = 0.049) forms were more frequent in group 1. The trabecular hematoma subtype was less common in group 1 (p = 0.002). INR (p = 0.004) and CRP values (p = 0.003) in the preoperative blood sample were significantly higher in group 1. History of ischemic stroke and intake of statins were more common in group 1 (p = 0.033, p = 0.04; resp.). In the multivariate analysis, midline shift (p = 0.033), occipital location (p = 0.005) and history of ischemic stroke (p = 0.046) remained significant. Conclusion: We could identify factors which contribute to DOC in CSDH patients. Among those are greater midline shift, occipital location and history of ischemic stroke as independent risk factors. |
| format | Article |
| id | doaj-art-9199bedc731747c581877e48a1b08c2c |
| institution | Kabale University |
| issn | 2214-7519 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
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| series | Interdisciplinary Neurosurgery |
| spelling | doaj-art-9199bedc731747c581877e48a1b08c2c2025-01-31T05:11:22ZengElsevierInterdisciplinary Neurosurgery2214-75192025-03-0139101992Risk factors for moderate disturbance of consciousness in patients with unilateral chronic subdural hematomaAdrian Liebert0Thomas Eibl1Thomas Bertsch2Hans-Herbert Steiner3Karl-Michael Schebesch4Leonard Ritter5Department of Neurosurgery, Klinikum Nuremberg, Paracelsus Medical University, Breslauer Straße 201, 90471 Nuremberg, Bavaria, Germany; Corresponding author at: Department of Neurosurgery, Paracelsus Medical University, Breslauer Straße 201, 90471 Nuremberg, Bavaria, Germany.Department of Neurosurgery, Klinikum Nuremberg, Paracelsus Medical University, Breslauer Straße 201, 90471 Nuremberg, Bavaria, GermanyInstitute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Klinikum Nuremberg, Paracelsus Medical University, Breslauer Straße 201, 90471 Nuremberg, Bavaria, GermanyDepartment of Neurosurgery, Klinikum Nuremberg, Paracelsus Medical University, Breslauer Straße 201, 90471 Nuremberg, Bavaria, GermanyDepartment of Neurosurgery, Klinikum Nuremberg, Paracelsus Medical University, Breslauer Straße 201, 90471 Nuremberg, Bavaria, GermanyDepartment of Neurosurgery, Klinikum Nuremberg, Paracelsus Medical University, Breslauer Straße 201, 90471 Nuremberg, Bavaria, GermanyObjective: Chronic subdural hematoma (CSDH) patients usually present with mild symptoms; however, a subset of patients presents with disturbance of consciousness (DOC). We analyzed clinical and radiographic factors, which could influence the level of consciousness in CSDH patients before surgery. Methods: We retrospectively analyzed consecutive unilateral CSDH patients, who were surgically treated in our department from 2018 to 2023. We compared a group of patients with moderate DOC (group 1), defined as a Glasgow Coma Scale (GCS) 9–13, with a control group of awake but symptomatic patients (GCS > 13, group 2). Clinical and radiographic parameters were analyzed in bivariate and multivariate analyses. Results: 41 (12.9 %) patients presented with GCS 9–13 and 276 patients with GCS > 13. In bivariate analysis, radiographic parameters, like greater mean midline shift (p < 0.001), homogenous hypodense type (p = 0.017), additional temporal (p < 0.001) and occipital (p < 0.001) location, “acute-to-chronic” (p = 0.002) and “acute-on-chronic” (p = 0.049) forms were more frequent in group 1. The trabecular hematoma subtype was less common in group 1 (p = 0.002). INR (p = 0.004) and CRP values (p = 0.003) in the preoperative blood sample were significantly higher in group 1. History of ischemic stroke and intake of statins were more common in group 1 (p = 0.033, p = 0.04; resp.). In the multivariate analysis, midline shift (p = 0.033), occipital location (p = 0.005) and history of ischemic stroke (p = 0.046) remained significant. Conclusion: We could identify factors which contribute to DOC in CSDH patients. Among those are greater midline shift, occipital location and history of ischemic stroke as independent risk factors.http://www.sciencedirect.com/science/article/pii/S2214751925000040Chronic subdural hematomaDisturbance of consciousnessGlasgow Coma Scale− surgery |
| spellingShingle | Adrian Liebert Thomas Eibl Thomas Bertsch Hans-Herbert Steiner Karl-Michael Schebesch Leonard Ritter Risk factors for moderate disturbance of consciousness in patients with unilateral chronic subdural hematoma Interdisciplinary Neurosurgery Chronic subdural hematoma Disturbance of consciousness Glasgow Coma Scale− surgery |
| title | Risk factors for moderate disturbance of consciousness in patients with unilateral chronic subdural hematoma |
| title_full | Risk factors for moderate disturbance of consciousness in patients with unilateral chronic subdural hematoma |
| title_fullStr | Risk factors for moderate disturbance of consciousness in patients with unilateral chronic subdural hematoma |
| title_full_unstemmed | Risk factors for moderate disturbance of consciousness in patients with unilateral chronic subdural hematoma |
| title_short | Risk factors for moderate disturbance of consciousness in patients with unilateral chronic subdural hematoma |
| title_sort | risk factors for moderate disturbance of consciousness in patients with unilateral chronic subdural hematoma |
| topic | Chronic subdural hematoma Disturbance of consciousness Glasgow Coma Scale− surgery |
| url | http://www.sciencedirect.com/science/article/pii/S2214751925000040 |
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