For older adults, a rising risk of subdural hematoma
You don’t have to hit your head to develop an insidious bleed between the soft covering of your brain and the brain itself that in days, weeks or months can threaten your health or life.
The condition, called chronic subdural hematoma, is becoming increasingly common as the population ages, prompting an New YorkUniversityLangoneMedical Center neurosurgeon, Dr. Uzma Samadani, to urge her colleagues to gear up for a growing number of cases likely to require neurological intervention.
By2030,whenafifthtoaquarter of the U.S. population will be older than 65, chronic subdural hematoma, or SDH, is expected to afflict 60,000 Americans a year, which would make it the most common reason for brain surgery, surpassing brain tumors and metastases, Samadani and colleagues reported last month in The Journal of Neurosurgery.
Head trauma from, say, a fall or another accident remains an important cause of the disorder, though in a third to a half of the cases, patients cannot recall an injury that might account for it. In many instances, the trauma, if there was one, was so trivial it was forgotten, like walking into an open cupboard door or hitting one’s head getting in or out of a car. Indirect trauma that jostles the brain is more common. About half of patients who report having fallen did so without hitting their heads.
James Reilly, 68, is a case in point. In early January, Reilly, who lives in Hoboken, N.J., said he fell out of bed while dreaming and broke a few ribs, but didn’t hit his head and seemed otherwise fine. But two months later, he developed difficulty speak- ing and using a computer, and a CT scan of his brain revealed a chronic SDH.
The lesion was surgically drained at the Veterans Affairs Medical Center in Manhattan, where Samadani is chief of neurosurgery and Reilly is a clerk in the department of neurology and physical medicine. He returned to his job last week.
The incidence of chronic SDH hasbeenrisingsteadilysince1967, with a third of the cases occurring in people older than 80. The recent report identified 695 new cases among 875,842 patients seen at the Veterans Affairs’ New York Harbor Healthcare System from 2000 to 2012. The condition is much more common among VA patients, compared with the general population. They are typically older men with a higher rate of additional risk factors, including heavy drinking or a history of