New horizons in subdural haematoma.
Age Ageing
; 52(12)2023 12 01.
Article
em En
| MEDLINE
| ID: mdl-38167695
ABSTRACT
Subdural haematoma (SDH) is a common injury sustained by older people living with frailty and multimorbidity, and typically following falls from a standing height. Anticoagulant and antiplatelet use are commonly indicated in older people with SDH, but few data inform decision-making surrounding these agents in the context of intracranial bleeding. Opposing risks of rebleeding and thrombosis must therefore be weighed judiciously. Decision-making can be complex and requires detailed awareness of the epidemiology to ensure the safest course of action is selected for each patient. Outcomes of surgical decompression in acute SDH are very poor in older people. However, burr hole drainage can be safe and effective in older adults with symptomatic chronic SDH (cSDH). Such patients need careful assessment to ensure symptoms arise from cSDH and not from coexisting medical pathology. Furthermore, the emerging treatment of middle meningeal artery embolisation offers a well-tolerated, minimally invasive intervention which may reduce the risks of rebleeding in older adults. Nonetheless, UK SDH management is heterogenous, and no accepted UK or European guidelines exist at present. Further randomised trial evidence is required to move away from clinical practice based on historic observational data.
Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Hematoma Subdural Agudo
/
Hematoma Subdural Crônico
Tipo de estudo:
Clinical_trials
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Guideline
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Prognostic_studies
Limite:
Aged
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Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article