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Chronic Subdural Hematoma with Hypodense on CT-Scan in the Elderly: Surgical Drainage or Conservative Treatment

Background: The treatment modalities of chronic subdural hematoma remain a matter of debate due to lack of management consensus. We performed a retrospective study to compare the clinical and radiological outcomes between surgical drainage and conservative management of hematoma with low density on computed tomography scan.

Methods and findings: We retrospectively reviewed medical records for 53 consecutive patients aged 70 years or older with hypodense hematoma treated in our department between 2008 and 2015. Patients were divided into a surgery group and a conservative group. Clinical outcome was evaluated according to the modified Rankin Scale on admission and follow up after treatment. Thirtyone patients underwent burr-hole surgery and twenty-two patients received conservative treatment at the first admission. Overall, the neurological and mental status of patients in both group were significant improvement from admission to follow-up. However, nearly 84% of patients were significantly improved in neurological status on 1-month follow-up exam in the surgical group, whereas only 55% of patients achieved a favorable outcome in the conservative group (p=0.02), yet no statistical difference on mean mRS scores was observed between the two groups.

Conclusion: Surgical drainage of chronic subdural hematoma with low density in elderly patients may be attributed to improve neurological status with lower incidence of recurrence, even in patients who has presented preexisting comorbidities and brain atrophy.


Yong-qian Wang, Ming-chang Gu, Qi Shi, Wei-ping Wang, Jian-yu Liu, Zheng-da Zhang and Qing-qi Feng

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